Background and Aim : New recent researches have shown role of inflammation in rheumatologic disease comorbid with depressive states. Therapeutic response is no favorable in these disorders and inside of some medications cause complications, drug-drug interactions. Poor compliance is other major concern about therapeutic alliance and suitable treatment. Also, role of gut microbial is eminent about psychiatric, psychosomatic and organic patients but it is a less known and orphan method for non-pharmacological treatment. Therefore, it suggests assessing gut microbial and various views of symptoms and treatment for these patients.Methods : It is as search in Scopus, PubMed and Google scholar from years of 2000-2021. Also, it is report of a case as clinical data and judgment.Results : Here, we present a 56-year-old, married, right-handed patient who is experienced chronic stage of typical systemic sclerosis with hands involvement. She was referred for the control of pain and redness in all her fingers, nightmare, insomnia and sleep disturbances. She also suffered with uncontrolled hands and feet shaking and restlessness during night. She used Ropixon, Angiopars, Methotrexate, Folicacid, Methylprednisolone, Magnesium and Selenium. There was no history of movement disorder. She also had complaint about recent hyperphagia and obsessed about being obese. No involvement had reported in her lung, heart and skin. The patient had a long history of hypo active sexual desire that recently exacerbated. No past personal psychiatric history and family history had been reported. She was menopaused with no history of hypothyroidism or other medical illnesses.Conclusion : We recommend for caution in prescription of drugs especially, Z drugs and benzodiazepines about these patients. Also, evaluation of psychiatric disorder especially depressive disorders and sleep problems is recommended. Assessment of dietary status, gut microbial is important, too. In some cases with poor response to treatment and GI upset, it suggests assessment of Gut microbial.