Could Vagus Nerve Stimulation Cure RA?by Lene Andersen, MSW Patient Advocate
“Vagus nerve stimulation cures rheumatoid arthritis!”
You may have seen this statement in multiple places over the past few years, but is it true? Can rheumatoid arthritis (RA) really be cured by stimulating a nerve in your neck? To find out, I took a look at the literature and conducted an email interview with Robert G. Hylland, M.D., a fellow of the American College of Rheumatology, and assistant clinical professor at the Michigan State University College of Osteopathic Medicine.
What is the vagus nerve?
“The vagus nerve is one of 12 pairs of nerves coming directly out of the brain,” explained Dr. Hylland.
It has two functions related to the immune system. First, “notifying the brain of an attack upon our body (by viruses, bacteria, and other noxious agents). The second function related to the immune system is “moderating that attack by quieting the immune response in order to prevent an over-reaction and unnecessary damage to our tissues and organs.” One of the ways the vagus nerve does this is by controlling the production of tumor necrosis factor (TNF), one of the molecules responsible for inflammation.
RA happens when the immune system mistakenly attacks our own tissues, the same way it would attack viruses and bacteria. In other words, the immune response overreacts. When someone has RA, the vagus nerve does not moderate that immune response.
Stimulating the vagus nerve affects RA
Vagus nerve stimulation has previously proven successful in people with epilepsy. In 2009, researchers suggested that stimulating this nerve could also be used in the treatment of arthritis, and in 2016, a study of vagus nerve stimulation in humans found that this was indeed the case. Dr. Hylland explained that “it is suggested that this improvement is in large part due to suppression of production of TNF, and perhaps Interleukin 6, by immune cells.” The names of these molecules may be familiar to you as being involved in some of the successful biologics, particularly TNF-blockers.
In order to stimulate the vagus nerve, a small device the size of a silver dollar is surgically implanted in the chest. An electrode would run from the device up to your neck to the vagus nerve, which would receive electrical stimulation one to four times a day. Think of it as a kind of pacemaker for the brain.
Several studies conducted on vagus nerve stimulation and RA have found that it has a high degree of safety, combined with a significant and sustained improvement of RA. More specifically, studies show a reduction in inflammation, joint pain, swelling, and tenderness. Research to date has involved a fairly small group of individuals with RA, and more studies are needed to create a better understanding of this treatment.
Does vagus nerve stimulation cure RA?
It is “highly unlikely” that vagus nerve stimulation will cure RA, Dr. Hylland said. However, “it may add to our armamentarium against this crippling disease, and without the medication side effects.”
Implementing this type of treatment will take a while. More research is still needed and Dr. Hylland expects that we are looking at five to 10 years before “legitimate U.S. Food and Drug Aministration-approved devices” are available in a clinical setting.
Vagus nerve stimulation is an exciting development in rheumatology. Its success in people who have not yet found a medication that works for them, plus the added benefit of treatment with a high degree of safety and little-to-no side effects, sound like heaven to people with RA.
It’s important, however, to be aware that this is not a cure, but rather a different type of treatment — with electrodes, rather than chemicals. Obviously, more research is required to confirm the effectiveness and safety of vagus nerve stimulation. Once vagus nerve stimulation is ready to be used in the clinical setting, it will be a welcome addition to the treatment options available for people with RA.