Reduction of Chronic Fatigue Through Transcranial Direct Current Stimulation and Low-Intensity Aerobic Exercise: A Case Study of Two Patients With Granulomatosis With Polyangiitis

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis that can lead to persistent pain and fatigue, significantly impacting patients' quality of life. This study assessed the effects of transcranial direct current stimulation (tDCS) combined with aerobic exercise as a non-pharmacological intervention for managing fatigue in GPA patients. Two patients were randomly assigned to receive either active tDCS or simulated tDCS stimulation (sham) during low-intensity aerobic exercise. The assessments included body mass index, fat and lean mass percentages, waist-to-hip ratio, C-reactive protein, erythrocyte sedimentation rate, and disease activity using the Birmingham Vasculitis Activity Score. Chronic fatigue was measured using the Modified Fatigue Impact Scale, the Fatigue Severity Scale, and the visual analog scale for fatigue. Sleep quality, activities of daily living, and functional capacity were evaluated through standardized tests. Results indicated that tDCS significantly reduced chronic fatigue by approximately 60%, nearly twice as much as the sham patient. Additionally, the tDCS patient showed improvements in physical activity levels, functional capacity, handgrip strength, daily activities, and sleep quality. In contrast, the sham patient showed declines in physical activity and minimal improvement in chronic fatigue. Overall, tDCS appears to be a promising intervention to enhance chronic fatigue and the quality of life in patients with GPA without causing disease reactivation or adverse effects.