4. Discussion
hand mobility, Pain, ischemia, systemic sclerosis, pain, SSc, ulcer, hand disability
VASODILATION, RARE DISEASE, PROLIFERATION, SYSTEMIC SCLEROSIS, ISCHEMIA, SCLERODERMA, ULCER, COMPLICATIONS
IDUs are common complications in patients with scleroderma [Our results showed a significant improvement in the functional capacity of the hand in both groups. This finding emphasizes the importance of using manual therapy in combination with pharmacological treatments for the management of IDU in patients with scleroderma. SSc patients with IDU have reduced hand mobility and increased global and hand disability compared to those without IDU [Another finding highlighted in our study was that significant pain relief was obtained only in the group that received a combination of manual therapy and therapeutic US, compared to patients treated with manual therapy alone. Pain management is of paramount importance in patients with IDUs. Moreover, in patients with systemic sclerosis, non-steroidal anti-inflammatory drugs (NSAIDs), despite their efficacy, should be avoided in favor of paracetamol and opiates due to their known vascular effects. The cause of pain in IDUs is tissue ischemia [Our study also suggests that ulcer healing seems to be better in the group of patients undergoing the combined treatment of manual therapy and therapeutic US, compared with the standard care group. In addition to the vasodilation induced by US, the mechanical action of this intervention might positively affect the wound tissue by promoting and stimulating cell proliferation [Finally, although a greater improvement in SF-36 score was observed in the treatment group, no significant improvement in quality of life was reported in any group. However, this finding should not be surprising as the main difficulties patients with systemic sclerosis complain about are in activities of daily living (ADLs), including walking, cleaning, and sports training [Furthermore, we did not make the comparison with a control group because the ethics of our department requires that all subjects with IDU undergo therapy. Finally, a rare disease causes a small sample.