Five patients with Felty's syndrome are described who were found at operation or at post-mortem, and in one case on percutaneous liver biopsy, to have nodular regenerative hyperplasia of the liver. Liver-function tests were slightly abnormal in three patients, and in three patients there was evidence of portal hypertension, one patient dying from bleeding oesophageal varices.This condition appeared to be truly related to Felty's syndrome for not a single instance of it was found in a post-mortem study of 51 patients with rheumatoid arthritis and of other series of patients with diseases associated with splenomegaly.Whether compression of intrahepatic vasculature from the nodular regenerative hyperplasia is an important factor in the portal hypertension that occasionally develops in Felty's syndrome, and whether an increase in splenic blood flow consequent on the splenomegaly by causing changes in portal blood flow or intrahepatic distribution of blood could be responsible for the change in hepatic histology requires further study.
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