Sacral nerve stimulation modulates disease activity and autonomic function in active rheumatoid arthritis: a...

Area of Science:

• Rheumatology
• Neurology
• Medical Devices

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation and pain.
• Current RA treatments aim to reduce inflammation and disease activity, but novel therapeutic approaches are needed.
• Sacral nerve stimulation (SNS) is an established neuromodulation technique for other conditions; its application in RA is unexplored.

Purpose of the Study:

• To assess the feasibility and safety of percutaneous sacral nerve stimulation (SNS) using acupuncture needles in active RA patients.
• To evaluate the potential effects of SNS on disease activity, pain, inflammation, and autonomic function in RA.

Main Methods:

• A pilot study involving 21 active RA patients randomized to receive 14 days of daily active SNS or sham stimulation.
• Disease activity was assessed using DAS-28, tender joint count (TJC), swollen joint count (SJC), VAS pain, ESR, and CRP.
• Secondary outcomes included patient-reported function, mood, inflammatory cytokines, and heart rate variability (HRV).

Main Results:

• The active SNS group showed significant within-group improvements in TJC, VAS, DAS28-ESR, and DAS28-CRP.
• No significant between-group differences were found for clinical or inflammatory markers after baseline adjustment.
• SNS significantly increased parasympathetic activity (rMSSD) compared to sham, an effect sustained after baseline adjustment.

Conclusions:

• Percutaneous SNS via acupuncture needles is a safe and feasible intervention in active RA patients.
• SNS demonstrated a potential to modulate autonomic function, specifically parasympathetic activity, in RA.
• Larger, powered trials are necessary to confirm the clinical efficacy and underlying mechanisms of SNS in RA management.