Balancing the autonomic nervous system, towards new therapeutic options for rheumatoid arthritis?

Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting approximately 1% of the western world population. Despite the broad range of medication available for RA, only a minority of patients reaches the treatment goal of remission or low disease activity. An exciting new approach could be to restore the balance in the autonomic nervous system. This thesis describes the role of the parasympathetic nervous system (PNS) on inflammation in the preclinical and clinical setting. Activation of the PNS via stimulation of the vagus nerve or by using α7nAChR-agonists consistently results in anti-inflammatory effects in animal models of arthritis. In RA patients we demonstrated an autonomic imbalance as well as in individuals at risk of developing RA, which may contribute to the disease development. Electrical stimulation of the vagus nerve in RA patients may alleviate clinical signs and symptoms and reduces pro-inflammatory cytokine levels. This work opens up a field that may lead to a completely novel way of treating chronic immune-mediated inflammatory diseases, by application of bioelectronic medicine or new pharmacological approaches.