Objectives: Currently, no studies have assessed the efficacy of transcranial direct current stimulation (tDCS) to treat fatigue and pain associated with or potentiated by post-COVID-19 syndrome in patients with systemic autoimmune rheumatic diseases (SARDs). Methods: This study included nine patients with different types of SARDs. All patients had previously confirmed RT-PCR test for COVID-19 as well as significant, persistent fatigue and pain that began to worsen after infection. Anodal tDCS was administered in five daily sessions (2mA, 20 minutes) over the C3 or C4 10/20 EEG positions, with the cathode placed at Fp1 or Fp2. Concomitantly, patients were involved in an aerobic exercise program by treadmill walking. All participants were evaluated using specific questionnaires and strength assessment by handgrip and physical function by timed-up-and go test and sit-to-stand test at baseline (within one week before tDCS protocol), and one week after tDCS protocol. During all procedures, the patients’ treatments remained unchanged. Results: The sample was composed of eight women and one man with a mean age of 48.7±9.6. After the tDCS protocol, the pain and fatigue significantly improved by a visual analog scale (P<0.05). The physical function also improved 9.5±2.7 vs. 6.8±0.8 (P=0.001) for timed-up-go-test and 10.3±3.7 vs. 15.1±4.0 (P=0.037) for sit-to-stand test. No subject experienced adverse events. One-hundred percent of patients adhered to all protocols. Conclusions: The present study showed tDCS in combination with aerobic exercise was effective in improving the physical function, and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.Clinical Trials: NCT04890483.
BACKGROUNDCurrent evidence has reinforced the contribution of pain and fatigue to the clinical parameters in patients with systemic autoimmune myopathies (SAMs). However, pain and fatigue are multidimensional symptoms affected by behavior-related factors such as mental health and sleep quality. Nowadays, no studies assessed the potential impact of mental health and sleep quality on fatigue and health-related quality of life in patients with SAMs.
METHODSAn observational cross-sectional unicenter study conducted from 2021 to 2022 enrolled 23 patients with SAMs: 8 (34.7%) with dermatomyositis (DM), 5 (21.7%) clinically amyopathic dermatomyositis (CADM), 4 (17.3%) with polymyositis (PM) EULAR/ ACR classification criteria (2017), 4 (17.3%) with the antisynthetase syndrome (ASSD) according to Baccaro et al. (2020), 2 (8.0%) with immune mediated necrotizing myopathy (IMNM) (Allenbech et al. 2020). Disease status was assessed by the International Myositis Assessment and Clinical Studies (IMACS) set scores. MMT-8, HAQ-, physician's and patient's VAS, and serum levels of muscle enzymes. The pain assessment was performed by McGill, Brief Pain Inventory and central sensitization questionnaire, and fatigue by modified fatigue impact scale (MFIS) and fatigue severity scale (FSS). Sleep quality by Pittsburg Sleep Quality Index (PSQI). Muscle endurance was assessed by Functional Index-3 (FI-3). The data were analyzed according to the distribution of the Spearman or Pearson correlation coefficient test.
BACKGROUNDIncreased pain perception is common in several rheumatic diseases also in patients with systemic autoimmune myopathies (SAMs). Current evidences suggests that pain not necessarily is associated with diseases-status. Nonetheless, few studies assessed the pain intensity and their relationship with disease parameters.
METHODSObservational cross-sectional study conducted during 2019 to 2022, which recruited 75 patients with SAMs 31 (41.3%) with dermatomyositis (DM), 6 (8.0%) clinically amyopathic dermatomyositis (CADM) EULAR/ACR classification criteria (2017), 26 (34.6%) with antisynthetase syndrome (ASSD) according to Baccaro et al. (2020), 7 (9.0%) with immune mediated necrotizing myopathy (IMNM) (Lundberg et al. 2017) and 79 individuals without rheumatic diseases as control group (CTR). Disease status were assessed by International Myositis Assessment & Clinical Studies (IMACS) set scores. MMT-8, HAQ-, physician's and patient's VAS, and serum levels of muscle enzymes. The pain was assessed by pain VAS. The comparation with general data between patients and CTR was performed by t-test and Mann-Whitney U test concerning about data distribution. The percentage values were analyzed by chisquare test for categorical variables.
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