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Panminerva Medica 2002 September;44(3):237-41

lingua: Inglese

The “submerged” connective tissue diseases

Scagliusi P., Tortorelli E., D’Amore M.

Department of Rheumatology University of Bari, Bari, Italy


Background. Many ­patients ­present ­with labor­a­tory abnor­mal­ities sug­ges­tive of con­nec­tive ­tissue dis­eases (CTD), but ­with a few clin­ical symp­toms, there­fore not ful­filling the cri­teria for a spe­cific diag­nosis. This ­fact led us to sup­pose the exis­tence of a change­able ­long “preclin­ical” ­phase in CTD devel­op­ment. In the ­past, we ­have ­already ­dealt ­with ­this sub­ject, but the exis­tence of a few ­reports under­lining ­this con­cept led us to ­describe ­some “par­a­dig­matic” clin­ical ­cases, and we sug­gest the def­i­ni­tion of “submerged connective tissue diseases (Sub-CTD)”.
Methods. During the ­last 5 ­years, we ­observed 25 ­patients (23 ­females and 2 ­males), ­with a ­mean age of 32 ­years, who ­were ­enrolled in a pros­pec­tive ­study, ­with a ­mean ­follow-up of 23 ­months. All the ­patients ­were ANA-pos­i­tive and ­went to our obser­va­tion pre­senting ­only 1 clin­ical ­symptom and ­other labor­a­tory abnor­mal­ities sug­ges­tive of CTD.
Results. The fol­lowing devel­op­ment of the clin­ical pic­ture ­allowed us to ­make a spe­cific CTD diag­nosis in 22 ­cases. The ­follow-up ­study ­shows the cor­re­la­tion ­between the ­starting symp­toms, the ser­o­log­ical ­markers (­detected at the ­first exam­ina­tion) and the defin­i­tive diag­nosis.
Conclusions. From ­this ­point of ­view, we empha­size the impor­tance of the detec­tion of ­very sen­si­tive and spe­cific ser­o­log­ical ­markers, ­which are ­useful for an ­early diag­nosis, par­tic­u­larly in ­this “sub­merged” ­phase of the dis­ease.

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