The Apollo Device in Systemic Sclerosis for the Management of fatiguE, Raynaud Phenomenon and qualiTy of Life

Inclusion Criteria:

1. Age ≥ 18 years

2. Ability to provide written informed consent,

3. Diagnosis of SSc, as defined by the 2013 ACR/EULAR classification of SSc64 with apositive ANA

4. Baseline score ≥55 on the FACIT-Fatigue scale,

5. Presence of Raynaud phenomenon with ASRAP-SF severity of T-score ≥40,

6. Steady daily doses and any immunosuppressive medication, vasodilators or othermedications used to treat pulmonary hypertension, antidepressants and anxiolytic usefor 4 weeks prior to baseline

7. Currently owns and operates an iOS or Android smart phone regularly

8. Ability to comply with the clinical visits schedule and the study-relatedprocedures.

Exclusion Criteria:

1. History of sympathectomy or stellate ganglion block

2. History of Botox injections to the digits within the last 3 months

3. Diabetes mellitus

4. Major surgery within 8 weeks

5. Hospitalization for any reason within four weeks of the study baseline visit

6. Active malignancy

7. Pregnant or breastfeeding women,

8. End-stage renal disease (estimated glomerular filtration rate < 15 mL/min/1.73m2) oron dialysis,

9. Hepatic insufficiency as defined by function worse than Child-Pugh Class B

10. Medication exclusions:

11. actively prescribed standing doses of beta-blockers,

12. actively prescribed standing doses of sedatives, hypnotics, opioids,benzodiazepines or anti-psychotic medications.