Assessment of the effectiveness of two-year rehabilitation on the functioning of patients with systemic sclerosis

Introduction
Systemic sclerosis (SSc, scleroderma) is a rare autoimmune disease characterized by fibrosis of the skin and internal organs. Skin sclerosis, especially around the joints, may lead to functional impairment. Dysfunction of internal organs, particularly of the respiratory and cardiovascular systems, significantly affects the patient’s physical performance.

Aim
To analyse hand joint function, strength, chest expansion, exercise tolerance using the 6-minute walk test (6MWT), and the range of temporomandibular joint (TMJ) movements in patients with systemic sclerosis treated at the Dermatology Clinic of PIM MSWiA following 2 years of physiotherapy.

Material and methods
The study initially included 55 patients – 42 women and 13 men – aged 27 to 80 years (mean: 56.4). The mean disease duration was 8 years. Ultimately, 45 participants completed the project: five changed treatment facilities, one switched to alternative methods, two developed cancer (prostate and breast), and two discontinued rheologic therapy due to treatment of other comorbidities.

Results
The final sample comprised 35 women and 10 men aged 28 to 80 years (mean: 57.6). Patients at the Dermatology Clinic received cyclic rheologic treatment. For 2 years, therapy was supported by physiotherapy involving individually adjusted facial mimic exercises, manual hand exercises, and self-massage of affected areas, performed at home and tailored to the patient’s range of motion. Before, during, and after the 2-year rehabilitation program, all patients were assessed for: Chest expansion, Six-minute walk test (6MWT), Left hand strength, Right hand strength, Mandibular abduction, Mandibular protrusion, Left lateral mandibular movement, Right lateral mandibular movement.

Conclusions
The study confirmed significant limitations in TMJ movement, hand joint mobility, grip strength, and chest expansion. When interpreting the 6MWT results, one must consider gait disturbances caused by lower leg and foot skin involvement, as well as organ dysfunction and musculoskeletal abnormalities.