Rehabilitation (includings hands)

In patients with systemic sclerosis (SSc) local disability of the hands and face, due to the involvement of skin, subcutaneous tissues and musculoskeletal system, is scarcely improved by pharmacological therapy, but may be treated efficaciously with rehabilitation, which can prevent and reduce local disability, thus ameliorating global disability and impaired Quality of Life, related to changes in the hands and face. In SSc, in order to be efficacious, rehabilitation should: 1. include and use both local treatments of hands and face and global rehabilitation techniques; 2. be different according to the different SSc phases and subsets; 3. include different techniques to tailor treatment to the personal needs and abilities of the patients. Systemic sclerosis (SSc) is a connective tissue disease characterised by microvascular changes, progressively leading to fibrosis of skin and internal organs and systems (lungs, heart, kidney, urogenital and gastrointestinal tract). Because of its complexity, SSc management should be carried out by a multidisciplinary team of physicians, coordinated by the rheumatologist. In SSc, the use of physiotherapy and rehabilitation programmes is advised to prevent and to reduce disability derived from cutaneous and musculoskeletal involvement. However, few studies on the subject are published, and rehabilitative therapy for SSc patients is not widely known and is not included in the EULAR recommendations for SSc management. Moreover, in daily practice, proper rehabilitation is seldom performed by physiotherapists and occupational therapists with specific skills in treating SSc patients. This review describes hand and face changes in SSc patients, their correlation with Global Disability and Quality of Life, and rehabilitation therapy, that include both local treatments of hands and global rehabilitation techniques.