Objective. In systemic sclerosis (SSc; scleroderma) patients in edematous phase, hand edema is often present. Manual lymph drainage (MLD) stimulates the lymphatic system and reduces edema. Our aim was to evaluate the efficacy of MLD in reducing edema and in improving functionality of the hands and perceived quality of life (QOL) in SSc patients in edematous phase. Results. In the intervention group, hand volume, the HAMIS test, and the 4 VAS were improved significantly at the end of treatment (P < 0.001). The results were maintained at T2 (P < 0.001). The HAQ and the PSI and MSI of the SF-36 also improved significantly at T1 (P < 0.001), but only PSI improvement was maintained at T2 (P < 0.001). In the observation group, no improvement at T1 and at T2 was observed. Conclusion. In SSc, MLD significantly reduces hand edema and improves hand function and perceived QOL.

Background: Systemic sclerosis (SSc) alterations of the face and of the mouth cause aesthetic modifications and disability, impairing self-esteem and quality of life (QoL). The aim of this study was to verify the effects of two rehabilitation protocols on facial mimic and mouth opening. Methods: A total of 47 SSc patients (40 females and 7 males, mean age ± SD 59.08 ± 10.31 years), were consecutively selected: 22 were randomly assigned to protocol 1 [home exercises for temporomandibular joint (TMJ), mimic, masticatory and cervical spine muscles] and 25 to protocol 2 (home exercises and combined physiotherapeutic procedures performed by a physiotherapist). Each treatment had a duration of 12 weeks with a follow up of 8 weeks. TMJ dysfunction, orofacial involvement, disability, QoL, and safety were assessed at enrollment (T0), at the end of the treatment (T1), and at follow up (T2). Results: Both Protocol 1 and Protocol 2 induced significant improvements of some clinical and clinimetric parameters, but better results were obtained with Protocol 2. In the comparison between the effects of Protocol 1 and Protocol 2 at T1 and T2, a significant difference was observed only for Mouth Handicap in SSc [MHISS; Total ( p = 0.00178] and for MHISS Mouth opening ( p = 0.0098) at T1. No significant difference of indices of short-form 36 was observed. Conclusion: The present data suggest that TMJ involvement in SSc may be managed by rehabilitation treatments. The action of a physiotherapist prescribing and personalizing exercises may induce better therapeutic effects.

Background:In SSc, skin involvement of the face is frequent and extremely disabling, resulting in limited mouth opening, an altered dentition, difficulty in teeth care, as well as having a strong impact on the emotional and psychological well-being, thus impairing quality of life.Objectives:to evaluate the efficacy of a self-treatment protocol (created by AMURR A Multidisciplinary Association of Rheumatological Rehabilitation) for face and tempomandibular joints (TMJs) rehabilitation with two devices used in the dental field.Methods:40 SSc patients (37 female and 3 male) with a mouth opening ≤ 40 mm, were recruited and randomized in two groups of treatment: Group 1 (20 patients: mean age 50,650 yrs ± 13,937 SD, mean disease duraton 10,45 yrs ± 7,877 SD, opening mouth 32,250 mm ± 5,590 SD) treated with a home self-treatment protocol consisting of 23 exercises carried out at home in front of a mirror, 22/23 exercises were performed once a day, one of these using a device to obtain uniform stretching of the buccal rhyme, another one usingused three times a day to reduce tension of muscles of the TMJs, facilitating the mouth opening; group 2 (20 patients: mean age 58,05 yrs ± 18,103 SD, mean disease duration 17,4 yrs ± 15,017 SD, opening mouth 34,950 mm ± 5,753) without physical rehabilitation, only drugs as treatments of SSc and its complications. All patients underwent a baseline (T0) and 45 days (T1) clinimetric assessment by self-assessment of quality of life with SF-36 (Short-Form 36 Health Survey), of the degree of disability of the mouth with MHISS (of the Mouth Handicap in Systemic Sclerosis scale), Muscle pain evaluated by numerical rating scale (NRS) of the temporomandibular joint with TMD (Temporo mandibular Disorders), evaluation of mouth opening and ROM of the cervical spine. Statistical analysis was performed using the t-test or the Mann-Whitney test for assessing changes in all measurement scales between treatment groups.Results:The protocol of home physiotherapy exercises resulted in a statistically significant improvement in the treated group compared to group 2 both for mouth opening (T0: 32,250 ± 5,590, T1: 35,650 ± 6,046) vs (T0: 34,950 ± 5,753 T1: 34,300 ± 6,001) (p<0.001), cervical flexion (T0: 2,950 ± 1,939 T1: 1.700 ± 1,525) vs (T0: 4,450 ± 2,282 T1:4,075 ± 2,238) (p<0.01), cervical extension (T0: 17,025 ± 1,895 T1: 17,625 ± 1,605) vs (T0: 17,050 ± 2,089 T1: 16,525 ± 3,110) (p<0.05), cervical right lateral flexion (T0: 14,075 ± 2,386 T1:13,400 ± 2,431) vs (T0: 14,200 ± 1,765 T1: 14,425 ± 1,742) (p<0.01), cervical right rotation (T0: 14,200 ± 3,416 T1:13,750 ± 3,206) vs (T0: 14,900 ± 1,683 T1: 15,550 ± 2,188) (p<0.01), cervical left rotation (T0: 14,725 ±3,640 T1:14,450 ± 3,710) vs (T0: 15,900 ± 2,614 T1: 16,450 ± 2,964) (p<0.05), mouth disability at MHISS (T0: 19,100 ± 10,356 T1: 16,000 ± 9,989) vs (T0: 20,950 ± 9,950, T1: 21,100 ± 10,775) (p<0.01).Conclusion:The use of the home exercises protocol associated with the two devices has shown a significant improvement of the disability linked to skin involvement of the face. This highlights the fundamental role that home rehabilitation self therapy has in practice. These data will need to be confirmed in a larger cohort of patientsDisclosure of Interests:Mauro Passalacqua: None declared, Cristian Foggi: None declared, Nicola Mauro: None declared, Lorenzo Tofani: None declared, Serena Guiducci: None declared, Cosimo Bruni Speakers bureau: Actelion, Eli Lilly, Gemma Lepri: None declared, Jelena Blagojevic: None declared, Khadija El Aoufy: None declared, Ginevra Fiori: None declared, Francesca Bartoli: None declared, Susanna Maddali Bongi: None declared, Marco Mitola: None declared, Marco Gizduloch: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim, Silvia Bellando Randone: None declared

Background In SSc patients, microstomia is frequent and impairs mouth function. It may be due to fibrosis of skin face and to changes in TMJ, scarcely evaluated and treated with rehabilitation in SSc. Objectives To evaluate, in SSc patients (pts) with microstomia due to TMJ dysfunction, the efficacy of 2 rehabilitation protocol. Methods We enrolled 26 SSc pts (22 women, 4 men; age and disease duration: 59.08±10.31 and 13.65±5.71 years) with microstomia and TMJ dysfunction. Group 1 (13 pts) was treated by Protocol 1 (P1) (home exercises for mimic, masticatory and neck muscles; 20 minutes/day, 3 days/week) and group 2 (13 pts) was treated by Protocol 2 (exercises plus face and neck,connective tissue massage, Kabat technique for mimic muscles, manual techniques -intra- and extra-oral manipulation of TMJ, stretching and mobilization of cranio-cervical muscles-; 1 hour/week). Pts were evaluated at T0, at T1 (end of treatment; week 12) and at T2 (at 8 weeks of follow-up) by: Helkimo Index (Anamnestic -A-dysfunction -D- and occlusal-O- index), for TMJ dysfunction; mobility of cervical rachis (cm) and mouth (ROM) (mm); SSc face involvement (facial skin score; Mouth Handicap in SSc scale–MHISS-). Results At T1, both protocols improved Helkimo A index and Helkimo O Score, while only protocol 2 improved Helkimo D (p<0.05).Mouth left lateralization and protrusion were improved by both protocols while mouth opening and right lateralization were increased only by P2 (p<0.05). At T1, P1 improved cervical anterior flexion and left rotation (p<0.05), with the latter result confirmed at T2 versus (vs) T0 (p<0.01), P2 ameliorated cervical right lateralization, while both protocols improved cervical left lateralization, right rotation and extension (p<0.05), with the latter result confirmed at T2 vs T0 for P1 and P2 (p<0.05). Both protocols reduced facial skin score at T1 (p<0.01), with the results confirmed at T2 vs T0 for both treatments (p=NS). P2 also improves at T1 vs T0 values of MHISS (p<0.05). T0 T1 T2 PT0/T1 P T0/T2 PT1/T2 Helkimo A P1 1.42±0.51 1.08±0.67 1.25±0.62 <0.05 NS NS P2 10.57±4,58 5.64±2,17 9.28±5,73 <0.05 NS NS Helkimo D P1 11.17±4.63 9.08±5.64 10.42±5.35 NS NS NS P2 10.57±4,58 5.64±2,17 9.28±5,73 <0.05 NS NS Helkimo score O P1 2.68±0.49 2.33±0.78 2.50±0.67 <0.05 NS NS P2 2.50±0.65 1.78±0.42 2.36±0.63 <0.01 NS <0.05 Mouth opening P1 42.83±9.51 44.42±13.83 45.08±9.18 NS NS NS P2 44.79±9.17 51.57±8.8 50.57±9.06 <0.001 <0.01 NS Mouth protrusion P1 7.5±2.47 10.63±2.42 9.08±2.61 <0.001 <0.05 <0.05 P2 7.21±2.63 8.71±2.16 8.5±1.74 <0.05 NS NS Cervical anterior flexion P1 3.92±1.16 3.00±0.47 3.54±0.78 <0.05 NS NS P2 3.03±1.47 2.18±1.25 2.5±1.27 NS NS NS Cervical extension P1 18.50±2.81 21.58±2.94 22.46±1.96 <0.001 <0.001 NS P2 17.64±2.5 19.79±1.80 19.86±2.98 <0.05 <0.05 NS Facial Skin Score P1 6.33±2.74 3.83±1,90 4.33±2.01 <0.001 <0.01 NS P2 6.43±2.44 2.93±1.94 3.0±2.07 <0.001 <0.001 NS MHISS P1 22.92±10.73 21.58±9.24 18.42±9.43 NS NS NS P2 22.43±10.43 13.64±7.81...