A completely new method of treating rheumatoid arthritis that does not involve drugs may be on the horizon.
In 2016, a team of researchers from several countries, including the U.S., reported that stimulating the vagus nerve with an electrical pulse appeared to inhibit the production of some of the inflammation-promoting proteins — called cytokines — commonly seen in people with RA.
The study, headed by physicians at the University of Amsterdam in the Netherlands, involved implanting a small medical device similar to a cardiac pacemaker under the skin in the chest wall and connecting wires from the device to the vagus nerve in the neck. The device, which is really a small electrical generator, was programmed to deliver small electrical pulses to stimulate the nerve up to four times each day.
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The vagus nerve is located on both the left and right sides of the body and runs from the brainstem through the neck into the chest and abdomen. One of the longest of all the cranial nerves, the vagus nerve serves several important functions. It regulates the heartbeat, breathing and sweating. It helps keep the larynx open during breathing and enables us to speak. It also connects to the stomach and gut, telling the brain when we’ve ingested food, then signaling that it’s been digested and triggering the brain to empty the digested food from the stomach into the intestines. It also controls bowel movements.
According to the Mayo Clinic, vagus nerve stimulation is most often used to treat epilepsy that does not respond to drug therapy. It is also used as a means of treating severe depression that has not responded to treatment with antidepressant medications, and it is increasingly being tried as a potential treatment for other conditions, including multiple sclerosis, pain, headache, Alzheimer’s disease, inflammatory bowel disease and RA.
“Vagal nerve stimulation as a treatment for RA is very exciting,” says Dr. Arundathi Jayatilleke, a rheumatologist and assistant professor of medicine at Drexel University College of Medicine in Philadelphia. “It has been tested in small groups for short periods of time with promising results in terms of improved symptoms, and with little risk of serious adverse effects. It is another facet of using bioelectronic devices for the treatment of different diseases, including inflammatory and autoimmune conditions,” she explains.
“The results of the [2016] study are promising,” echoes Dr. Bharat Kumar, an immunologist specializing in rheumatology and allergies in Iowa City, Iowa.
Exactly how vagus nerve stimulation works is not well-understood.
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“In the past, it was thought that the nervous system and the immune system spoke in two different languages. Nerves largely communicate with electrical signals, while immune cells talk via chemical messengers,” Kumar explains. “We’re now starting to realize that these aren’t foreign languages, but more like dialects with a lot of overlap. However, we don’t really know most of the words or even the grammar of this common language. Certain nerves do release chemicals that impact immune cells, and immune cells do impact the electrical signals between nerves. But how exactly this happens is an unanswered question,” he adds.
“[It] has been proposed that the vagus nerve stimulates the splenic nerve, which then causes a set of immune cells, called T cells, in the spleen to release a neurotransmitter, which then tells another set of immune cells, called macrophages, to stop producing inflammatory cytokines like tumor necrosis factor,” Jayatilleke says, noting that “the pathway has not been fully explained.”
“It makes sense to me that the vagus nerve, in particular, interacts with the immune system because of its other functions,” Kumar notes. “It helps regulate heart rate, breathing and bowel movements. The immune system is just as vital for human health as the heart and the lungs, so it doesn’t surprise me that the vagus nerve has a role in immunity.”
However, there is a caveat.
“It’s a little too early to say if it may become a viable treatment,” says Kumar, a clinical assistant professor of medicine in the Department of Internal Medicine at the University of Iowa Hospitals and Clinics. “Only 17 people were included in this study, which makes it difficult to generalize to all patients with RA.”
So, just when and how the vagus nerve stimulating device will be used for RA is not known.
“In the study, the device was only used for people with severe, poorly controlled RA,” Kumar says. “I see the device having that same adjunct role whenever this [treatment] may [be available].”
“Until larger-scale research is done, it is hard to see vagus nerve stimulation as a first-line treatment,” Jayatilleke agrees. “Some patients may not benefit from this method.”
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“Also, surgery carries its own risks, especially in poorly controlled RA, which makes me feel that it is unlikely to become a first-line treatment,” Kumar adds.
“Still, it seems like an amazing potential treatment, especially given that the standard drug treatments for RA have many risks and don’t work for everyone,” Jayatilleke notes. “The thought of harnessing vagus nerve stimulation to control inflammation is very exciting, just because it is such a different way of approaching inflammatory conditions. It would be interesting to see if it had similar positive effects in other rheumatologic conditions, such as lupus,” she adds.
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Promising New Non-Drug Treatment for Rheumatoid Arthritis on the Horizon originally appeared on usnews.com
