Clinical trials involving nerve stimulation to reduce production of pain producing substances promises better life for Rheumatoid arthritis patients
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease of the joints that leads to limitation in joint movement, deformed joints, inability to perform simple tasks of daily life and overall poor quality of life. Presently there are many pharmacological options for reducing pain like glucocorticoids, methotrexate, monoclonal antibodies, and other agents that target inflammatory mechanisms, but the pain and deformity still persist preventing the patient from leading a fulfilling life.
But recent advances at the intersection of immunology and neuroscience have resulted in a possible solution to end the pain –inflammation –pain- disability cycle thus promising a better life not only for rheumatoid arthritis patients but exciting prospects for those with other autoimmune diseases as well.
Though neural stimulation has been used for years to manage epilepsy and also treat certain cases of Parkinsonism recently conducted clinical trials have established a link between reflex neural pathways and autoimmune diseases. According to the trials reflex neural pathways result in the production of pain producing substances like Cytokines and Tumor necrosis factor (TNF) by the monocytes and macrophages (immune cells present in the blood). One such reflex neural cytokine inhibiting pathway has been identified in cases of rheumatoid arthritis which involves the Vagus nerve. Clinical studies carried out on a handful of persons with rheumatoid arthritis have demonstrated significant reduction in TNF concentration (main pain causing molecule in RA patients) on stimulation of the Vagus nerve, four times a day using implantable device. The disability scores taken at the end of 84 days showed a positive change indicating reduced disability and pain and better quality of life.
Though the study needs to be done on a larger number of patients to establish definite clinical reliability, it is definitely a landmark step in the right direction for alleviating pain and attenuating disability in patients with late stage rheumatoid arthritis and other autoimmune diseases.
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