Perhaps one of the biggest challenges after being diagnosed with Rheumatoid Arthritis (RA) is that while there are numerous treatment options, finding the right one for individual patients can be difficult.
Drug combinations and dosages vary from one patient to another. While some respond quite well to disease-modifying antirheumatic drugs (DMARDS), others suffer through terrible side effects. Biologics are another option to achieve low disease activity and even remission, however not all respond well to it. Some patients aren’t able to take specific medication because of their medical history or personal risk factors. The point is, there’s a lot of trial and error involved in the treatment of RA; and while some successfully find their right medication cocktail, others continue to try drug after drug and fail to find a combination that’s effective.
The Vagus Nerve
In the quest to find an alternative, maybe even better, treatment option, scientists are looking into something called vagus nerve stimulation.
The treatment isn’t dependent on drugs, which could be a welcome respite for many RA patients who are used to taking numerous pills, injections, or infusions to manage disease activity. Instead, this method uses electrical impulses to stimulate the vagus nerve—a cranial nerve that runs from the brain through the face and neck, all the way down to the abdomen.
As the longest of the cranial nerves, it’s a critical part of the body’s overall autonomic nervous system. It’s responsible for controlling essential bodily functions that we don’t even have to worry about such as breathing, beating of our heart, or digesting food.
What does it have to do with RA? The vagus nerve is also home to the body’s inflammatory reflex—which is responsible for detecting and regulating inflammation. So for example, if you get injured or get infected by a virus or bacteria, the vagus nerve helps determine the level of your body’s immune response to fight it. When the response is well-regulated and appropriate, it manages to kill off the virus or bacteria, allowing our body to heal. But there are instances when it gets too aggressive and goes on overdrive; that’s when you end up with chronic inflammation. In RA, this results in joint and tissue damage.
An Experimental Approach
To date, the scientific community doesn’t exactly know what causes RA. However, they can confirm that inflammatory substances called cytokines—including tumor necrosis factor (TNF) and interleukin (IL)–play a major part in tissue damage. This is why RA drugs like biologics are designed to target these specific cytokines. But these treatments don’t always work for everyone.
That’s where the vagus nerve comes in. The vagus nerve is known for reducing the production of cytokines and the theory of this new approach is, stimulating the vagus nerve could help minimize the production of cytokines that cause inflammation.
“The silver dollar-sized device is implanted into the chest and delivers electrical signals (via an electrode that runs up to the neck) that in essence tells the immune system “enough inflammation already!””
A Promising Treatment
Current studies are small but promising.
In addition to efforts to determine the safety of the device, most of the patients who used the MicroRegulator used to stimulate the vagus nerve reported significant improvements to their RA disease activity scores. Lowered cytokines were also noted.
While there were some adverse effects, including pain and swelling at the incision site and one patient who experienced vocal cord paralysis, all these were fortunately, temporary.
A separate study is also looking into how a vibrational device that you can hold to your ear could also help stimulate the vagus nerve and limit the production of cytokines.
Simultaneous to these studies, researchers are also looking into understanding how they can best determine whether or not RA patients will respond to available medication. Again, the key could lie in the vagus nerve as research has shown that low vagal tone is linked to higher inflammation and greater risk of autoimmune conditions. This means RA patients with low vagal tone could be ideal candidates for vagus nerve stimulation.
A device currently being developed could be used by rheumatologists to help assess whether a patient is more likely to respond to biologics or have better chances with emerging treatment options such as vagus nerve stimulation.
Should future studies prove to be positive, vagus nerve stimulation can be a viable treatment option or RA patients who don’t respond to DMARDs or biologics. Additional research is also looking into how electrical nerve stimulators can be used in tandem with drug therapies to help boost their efficacy.
It’s a promising new option for millions of RA sufferers–one that could potentially be life-changing for improving disease activity and quality of life.