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BackgroundAlthough effectively controlling inflammation, up to 50% of patients with rheumatoid arthritis (RA) experience persistent pain, associated with central sensitization and neuroinflammation. Home-based transcranial direct current stimulation (tDCS) has shown efficacy in chronic pain.ObjectiveTo investigate whether anodal tDCS (a-tDCS) is more effective than sham stimulation in reducing pain.MethodsRandomized, double-blind, sham-controlled trial with 34 women (18–70 years) with RA and VAS > 40 mm. Participants were randomized to receive a-tDCS (n = 17) or sham tDCS (n = 17). Home-based tDCS (2 mA, 20 min/day) or sham (2 mA, 90 s) for four weeks, using anodal-left M1 montage. Primary outcomes was pain (Visual Analogue Scale, VAS), Secondary outcomes included pressure pain threshold (PPT), central sensitization (CSI), physical function (HAQ-DI), fatigue (FACIT-F), CNS biomarkers, adherence, and safety.ResultsMean VAS reduction from baseline was greater in the a-tDCS group (-33.5 mm) versus s-tDCS (-14.1 mm), with a between-group difference of -19.4 mm (95% CI, -29.3 to -9.5; p = 0.003). Linear mixed-effects models showed that a-tDCS reduced VAS pain by 27.7% versus 6.0% with sham, a between-group difference of 21.7% (Cohen’s d = 1.15). HAQ-DI improved by 38.0% versus 7.2% (ES = 1.10). a-tDCS reduced analgesic use by 62% (RR = 0.38; 95% CI, 0.18–0.79). Exploratory analyses suggested that neuroplasticity mechanisms might mediate these effects.ConclusionHome-based a-tDCS effectively reduced pain, disability, and analgesic use in RA patients with persistent pain without objective inflammation.

IntroductionSystemic sclerosis (SSc) often leads to decreased muscle strength and mass, impairing physical performance and causing disability. Interventions with resistance exercise (RE) is an effective non-pharmacological approach to mitigate these issues. This systematic review aims to evaluate the effects of interventions with RE on muscle strength, muscle mass, physical performance, physical disability, and quality of life (QOL) in SSc patients, as well as to assess its adherence and safety.MethodsA systematic review and meta-analysis were conducted based on a PICOS framework: Patient = Systemic Sclerosis; Intervention = Resistance exercise; Study design = Randomized clinical trials. Searches were performed across MEDLINE (PubMed), PMC, Web of Science, Cochrane Library, LILACS, and EMBASE up to January 2025.ResultsTen randomized clinical trials, including 422 participants (~85% female), were eligible for analysis. Participants’ ages ranged from 42 to 64 years, with body mass indices between 22.5 and 28.0 kg/m2. The intervention period was standardized to 12 weeks. Interventions with RE significantly improved muscle strength (SMD = 2.76 kg; 95% CI, 1.32 to 4.20; p = 0.0002) and functional disability (SMD = −0.47; 95% CI, −0.93 to −0.00; p = 0.05) compared to controls. Interventions with RE also showed superiority in the physical component of QOL (SMD = 0.42; 95% CI, 0.04 to 0.81; p = 0.03). Although enhanced physical performance was observed, statistical pooling was not possible due to limited data. Interventions with RE had a low incidence of adverse events, but data on disease progression and adherence were insufficient.ConclusionInterventions with RE benefits muscle strength, physical function, and QOL in SSc patients, though optimal protocols and adherence strategies need further investigation. More robust studies are required to refine training methods and enhance clinical trial designs.

Background Rheumatoid arthritis (RA) is a systemic autoimmune disease with articular and extra-articular manifestations. Chronic inflammation may contribute to sarcopenia independently of age. While cross-sectional studies report sarcopenia in 24–30% of RA patients, longitudinal data remain limited. This study aimed to assess long-term changes in sarcopenia and body composition in RA patients and explore their associations with clinical features and health outcomes. Methods In this prospective cohort study, 90 RA patients were followed for a median of 6.4 years (IQR: 5.8–7.0). Clinical features, falls, fragility fractures, and mortality were recorded. Body composition (BMI, appendicular lean mass index [ALMI], fat mass index [FMI]) was assessed using dual-energy X-ray absorptiometry; grip strength by JAMAR dynamometer; and physical performance by the Timed Up and Go test. Sarcopenia was defined using EWGSOP2 criteria. Statistical analyses included ANOVA, Kruskal–Wallis, chi-squared tests, generalized estimating equations, Kaplan–Meier curves, and regression models. Results At baseline, mean age was 56.5 ± 7.3 years, median disease duration 8.5 years (IQR:3.0–18.0), median DAS28-CRP 3.0 (IQR:1.0–3.0), and mean HAQ-DI 1.1 ± 0.9. Seven patients (7.7%) had sarcopenia, including one severe case. Most participants were overweight with elevated FMI. Sarcopenia prevalence and clinical characteristics remained stable, with no new sarcopenia cases during follow-up. ALMI increases were associated with FMI increases ( p  = 0.005). Baseline sarcopenia was not associated with falls, fractures, or mortality. Low muscle mass and poor physical performance were not linked to mortality, but low muscle strength showed a trend toward higher mortality risk (HR = 4.35, 95% CI: 0.51–37.25). After adjusting for age, disease duration, glucocorticoid dose, and DMARD use, low muscle strength was significantly associated with falls (B = 3.92,95% CI:1.03–15.02; p  = 0.046). No associations were found for low muscle mass, low physical performance, or sarcopenia with these outcomes. Conclusion In RA patients receiving regular care, sarcopenia prevalence remained high and stable. Low muscle strength was associated with falls and showed a trend toward increased mortality risk, possibly due to limited sample size, highlighting its potential prognostic value. However, the absence of a control group limits interpretation, as observed changes may reflect normal aging rather than disease-specific effects. Clinical trial number Not applicable.