Neuromodulation for Rheumatoid Arthritis

Medically Reviewed by David Zelman, MD on April 03, 2022
3 min read

The usual medications for rheumatoid arthritis don’t work for everyone with the condition. Some have bothersome side effects, like an increased risk of infection. And some can be very expensive.

These issues have led researchers to seek other treatment options. One of them is neuromodulation, in which a device is used to disrupt nerve messages, and thus fight inflammation, in your body.

Neuromodulation can be done with either chemical or electrical stimulus. For RA, scientists are looking into using electrical currents.

You might get the current through a device either outside your body or implanted inside it. Researchers are focused on stimulating two nerves to treat RA: the vagus and the splenic.

You have two vagus nerves, one on each side of your brain. They run through your neck into your chest and abdomen. For years, doctors have used devices that stimulate the vagus nerve to treat epilepsy and severe depression.

The vagus nerve plays an important role in regulating your immune system. Some RA research is focused on the vagus nerve as a path to reducing the cytokines your body makes. Cytokines are proteins involved in the inflammatory process.

The vagus nerve also helps your body respond to stress. Doctors believe stress can make conditions like RA worse.

Your spleen is just above your stomach, on the left side of your abdomen. It’s part of your lymphatic system. That system is a key piece of your body’s immune response.

Because it’s part of your immune system, scientists are looking at the spleen -- and the nerve that serves it -- in studies of autoimmune disorders.

One way to create vagus nerve stimulation -- also known as VNS -- is to implant a device near your collarbone. The concept is similar to that of a heart pacemaker. In this case, doctors use a device to send electrical signals to your brain instead of your heart.

The procedure to place the device is usually outpatient surgery, done under general anesthesia.

Research shows that people with rheumatoid arthritis who used these implants made fewer cytokines, and their RA symptoms improved. Studies on implanted vagus nerve stimulators are ongoing.

Implanted devices aren't a good choice for some people. That includes those who have:

  • Heart problems
  • Lung diseases, including asthma
  • Problems with fainting
  • Ulcers

People with epilepsy and drug-resistant depression are already using neuromodulation devices for their conditions. Side effects have included:

  • Hoarseness
  • Coughing
  • Voice changes
  • Throat pain or spasms
  • Headache
  • Insomnia
  • Indigestion
  • Nausea or vomiting
  • Tingling or prickling skin

If an implanted device isn't right for you, doctors have also started using devices outside the body to stimulate the vagus nerve. They were originally developed to treat migraine headaches and seizures.

In one small study, people with RA held a vibrating device to their ear to stimulate their vagus nerve. The device was placed just above the ear opening. The study participants made fewer cytokines, and their inflammation levels were lower. Scientists want to study this approach further.

In another study, people with RA held a device to the outside of their necks to stimulate the vagus nerve. People with more serious RA saw a decrease in their disease activity.

In a third study, people with RA wore a device similar to an earbud, which delivered electrical pulses up to 30 minutes a day for 12 weeks. The participants noticed an improvement in their RA symptoms. Researchers are doing more studies of this device.

Your doctor can help you find out whether you are a candidate to participate in similar studies.

Splenic nerve stimulation is an experimental approach that involves surgery to implant a device near your spleen. As of 2022, scientists are recruiting patients willing to participate in the research. Researchers would implant a device that stimulates the splenic nerve into participants and then monitor their bodies to see how well it worked.

To be eligible, you must meet these criteria:

  • You are 22 to 75 years old.
  • You have active RA.
  • Your RA must have started in your adult years and have lasted at least 6 months.
  • You must have tried at least two DMARDs or JAK drugs without success.
  • You must meet other criteria regarding your current treatment regimen.

Your doctor can tell you whether you qualify for a clinical trial.