What is your approach to further work-up and management of neutropenia in patients with SLE/RA overlap?

This is an interesting situation that comes up in the routine evaluation of patients with rheumatoid arthritis and other autoimmune syndromes. The normocellular bone marrow suggests a peripheral destruction, in general, and raises some concerns for antibodies directed against neutrophils. These are commercially available tests that are worth ordering. There is an assumption there that the peripheral smear and the peripheral cells have been assessed for T and B cell subsets, to rule out a Felty's...

Agree with @Dr. First Last.

For the young folk reading this thread (sorry to say we are not young folk, Paul), what we used to call "LGL syndrome" is now called RA-associated T-cell large granular lymphocyte leukemia. It used to sound a lot less scary to our patients when we could say LGL syndrome. I've only had 3 patients with this in 25 years. All did really well with MTX (which is the drug of choice for both LGL and RA). My local heme/onc I work with guides me with stating to stay the course ...