Undifferentiated connective tissue disease (UCTD) (also known as latent lupus or incomplete lupus) is a disease in which the connective tissues are targeted by the immune system. It is a serological and clinical manifestation of an autoimmune disease. When there is proof of an autoimmune disease, but the disease does not correspond to any specific autoimmune disease (such as systemic lupus erythematosus (SLE), scleroderma, mixed connective tissue disease, Sjögren syndrome, systemic sclerosis, polymyositis, dermatomyositis, or rheumatoid arthritis), it will be diagnosed as UCTD. This is also the case of major rheumatic diseases whose early phase was defined by LeRoy et al in 1980 as undifferentiated connective tissue disease. The term is sometimes used interchangeably with mixed connective tissue disease (MCTD), as it is an overlap syndrome. However, some researchers believe that MCTD is a clinically distinct entity and is strongly associated with the presence of titer high in antibodies Ribonucleoproteins (RNP). It is estimated that up to 25% of people with systemic autoimmune disease could be considered to have UCTD. There are many people who have features of connective tissue disease, such as blood test results and external characteristics, but do not fulfill the diagnostic criteria established for any one disease. These people are considered to have undifferentiated connective tissue disease (UCTD).
Classification UCTD is not specifically included in the WHOs ICD-11 disease classification system, but may be included in the 'diseases of the immune system' group.
Signs and symptoms The presentation of the disease varies considerably from one patient to another. Generally, the symptoms include nonspecific symptoms common to connective tissue diseases such as
fatigue – this is common in autoimmune diseases, and is the patient's primary concern malaise fever These can be the initial presentation for some patients. Other symptoms associated with UCTD include :
joint pain – the most common symptom, occurring in up to 86% of patients. The pain is often an aching or arthritis-like pain in the elbows, wrists, hands, and knees, in a symmetrical pattern. dry eyes dry mouth hair loss joint inflammation mouth ulcers Raynaud's phenomenon sun-sensitive rash Clinical presentation in some people diagnosed with UCTD may show :
positive antinuclear antibody (ANA) test. Patients with UCTD usually have positive ANA. a decrease in the number of white blood cells anemia abnormal nerve sensations in the extremities inflammation of the lining of the heart and/or lungs a decrease in platelet count Pulmonary involvement, such as nonspecific interstitial pneumonia, can be a complication of the disease.
Mechanism UCTD is caused by genetic and environmental factors. It may be triggered by factors such as:
Exposure to harmful products such as cigarette smoke. Exposure to an atmospheric pollutant, primary air pollutants (nitrogen oxides [NOx], sulfur dioxide [SO2], volatile organic compounds [VOCs], hydrocarbons and certain metals [such as lead or cadmium]) or secondary (created in the atmosphere through chemical reactions between pollutants). Exposure to UV light.
T-cell hypothesis Populations of regulatory T cells are believed to be responsible for the onset of the disease. When there is a decline of these cells, manifestations of diseases begin to appear, giving an idea of the vital role of these cells in the prevention of autoimmune diseases. Moreover, an additional decrease could, unfortunately, worsen the pathological state and lead to the differentiation of an undifferentiated connective tissue disease into a differentiated connective tissue disease with a poorer prognosis. Due to the wide range of variation in the inclusion criteria of the disease, up to 50% of patients diagnosed with connective tissue disease may have undifferentiated disease of the underlying connective tissue.
Diagnosis and research inclusion
Diagnosis There are no formal diagnostic criteria for UCTD. It is determined by a differential diagnosis. Diagnostic tests are undertaken to determine whether a patient has a disease assured or undifferentiated of the connective tissues. Patients with UCTD usually have positive ANA (antinuclear antibody), and raised ESR (erythrocyte sedimentation rate) values, without typical autoantibody specificities. Some 20% of the general population, and up to 15% of completely healthy people, test positive for ANA, but this is regarded by some as almost always a sign of an autoimmune disorder. If more specific types of ANAs or other proteins are present, other autoimmune conditions (not UCTD) are implied. Other mechanisms that may be used are tests for Anti-histone antibodies, Chromatin and vitamin D, and chest X-ray to show signs of pericardial effusion.
Classification criteria Patients may be included for UCTD research if they have:
Signs and symptoms which (a) are suggestive of a connective tissue disease, but (b) do not meet the criteria of any defined connective tissue diseases, and (c) have lasted for at least three years. (Note, if less than three years, may be regarded as early UCTD). Positive ANA test on two different occasions.
Treatment UCTD is normally managed primarily as an outpatient. Meds can be used to manage aspects of the disease. Treatment depends largely on the progression of the individual disease and the nature of the symptoms presented. Antimalarial medications, corticosteroids and other medications may be prescribed, as the treating physician considers appropriate:
Nonsteroidal anti-inflammatory drugs for pain. Anti-inflammatory corticosteroids In severe cases, immunosuppressive drugs may be used.
Antimalarial medications (like hydroxychloroquine) can inhibit chemotaxis of neutrophil and eosinophil. Calcium channel blockers can be used to relax smooth muscles and decrease the resistance of the peripheral vascular system. This can help in managing Raynaud's phenomenon.
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