title: The "submerged" connective tissue diseases.
abstract: 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.
authors.affiliation: Department of Rheumatology, University of Bari, Bari, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Scagliusi
authors.forename: E
authors.initials: E
authors.lastname: Tortorelli
authors.forename: M
authors.initials: M
authors.lastname: D'Amore
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000032:analysis; D003240:Connective Tissue Diseases / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012698:Serologic Tests
chemical_list: D001323:Autoantibodies