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.
Objective: To assess general pain and fatigue and their association with the disease status of patients with systemic autoimmune myopathies (SAMs), in terms of the impact of the COVID-19 pandemic on these parameters. Methods: This is a cross-sectional and prospective cohort study that included 72 patients with SAMs who were matched by age and gender with 67 healthy individuals. The patients engaged in an interview via a validity survey to measure disease status, and assess a visual analog scale (VAS) for pain and fatigue in two periods: before (phase I) and during (phase II) of the Brazilian COVID-19 pandemic. For cross-sectional analysis, patients' data from phase I were compared to healthy individuals' information, whereas for prospective analysis, data of the patients who were assessed in phase II were compared to the same patients' data from phase I. Results: The patients had significantly more pain perception, comparable fatigue perception and fatigue severity, when compared to the healthy individuals. During the COVID-19 pandemic period, the disease activity, pain and fatigue perceptions, and fatigue severity remained unchanged. Despite this, the pain and fatigue perceptions correlated significantly with patients' VAS, the patient health outcome, and fatigue severity. In addition, the pain perception correlated to creatine phosphokinase, whereas fatigue perceptions correlated to physicians' VAS. Conclusions: The study showed that patients with SAMs have significantly increased pain perceptions compared to healthy individuals. During the COVID-19 pandemic period, the pain and fatigue perceptions remained unchanged in patients with SAMs but they correlated to several disease status parameters.
We described herein a patient who presented an overlap syndrome of childhood-onset systemic polyarteritis nodosa (c-PAN) and childhood-onset systemic lupus erythematosus (c-SLE). A 9-year-old girl presented tender subcutaneous nodules on feet, arterial hypertension, right hemiplegia and dysarthric speech. She was hospitalized due to stroke and left foot drop. Brain computer tomography showed ischemic stroke. Magnetic resonance angiography revealed stenosis in the middle cerebral and internal carotid arteries. Electroneuromyography identified a mononeuropathy of left posterior tibial nerve and she fulfilled the c-PAN validated criteria. She was treated with intravenous methylprednisolone pulse therapy followed by prednisone, that was progressively tapered, six months of intravenous cyclophosphamide and after that she received azathioprine for 19 months. At the age of 14 years and 9 months, she presented malar rash, photosensitivity, edema in lower limbs and arterial hypertension. The proteinuria was 1.7g/day. Antinuclear antibodies (ANA) were 1/1280 (homogeneous nuclear pattern) and anti-dsDNA antibodies were positive. Renal biopsy showed focal proliferative and membranous glomerulonephritis. Therefore, she fulfilled the American College of Rheumatology classification criteria for SLE and she was treated with prednisone, hydroxychloroquine and mycophenolate mofetil. In conclusion, we described herein a possible overlap syndrome of two autoimmune diseases, where c-PAN occurred five years before the c-SLE diagnosis.
BACKGROUNDCurrently, no studies have evaluated the safety and efficacy of transcranial direct current stimulation (tDCS) in systemic autoimmune rheumatic disease patients with fatigue and pain-associated with post-COVID-19 syndrome.
BACKGROUNDCurrently no studies have assessed general pain and fatigue and their association with the disease status of patients with systemic autoimmune myopathies (SAMs) in terms of the impact of the COVID-19 pandemic on these parameters. This lack of research motivated us to assess the present study.
METHODSThis is a cross-sectional and prospective cohort study that included 72 consecutive patients with SAMs who were matched by age and gender with 67 healthy individuals. The patients engaged with a face-to-face interview via validity survey to measure disease status, assess a visual analog scale for pain and fatigue, and fatigue severity in two periods: January 2020-March 2020 (before the Brazilian COVID-19 pandemic, phase I), and December 2020-March 2021 (during the pandemic, phase II). For cross-sectional analysis, patients' data from phase I were compared to healthy individuals' information, whereas for prospective analysis, data of the patients who were assessed in phase II were compared to the same patients' data from phase I. The data distribution was assessed by Shapiro-Wilk adherence test and the group was compared with student's t-test or Mann-Whitney test. Correlation was assessed by Pearson or Spearman correlation. Weak correlation was considered with rho < 0.30 (weak); rho = 0.30 to 0.49 (moderate), rho = 0.50 to 0.69 (strong) and rho ≥ 0.70 (very strong). P values ≤ 0.05 were considered statistically significant. Values of p ≤ 0.05 were considered statistically significant.
RESULTSIn general, patients with SAMs had stable disease. The patients had significantly more pain perception, comparable fatigue perception and fatigue severity, and a tendency of reduced physical activity levels when compared to the healthy individuals (Table 1). During the COVID-19 pandemic period, the disease activity, pain and fatigue perceptions, fatigue severity, and physical activity levels remained unchanged (Table 2). Despite this, the pain and fatigue perceptions correlated significantly with patients' visual analogue scale, the patient health outcome, and fatigue severity. In addition, the pain perception correlated to creatine phosphokinase, whereas fatigue perceptions correlated to physicians' visual analogue scale (Table 3).
CONCLUSIONThe study showed which patients with SAMs have significantly increased pain perceptions compared to healthy individuals. During the COVID-19 pandemic period, the pain and fatigue perceptions remained unchanged in patients with SAMs but they correlated to several disease status parameters.
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