A new approach to rheumatoid arthritis: treating inflammation with computerized nerve stimulation

Abstract

Doctors currently treat rheumatoid arthritis, a crippling autoimmune disease, with an arsenal of drugs that, while often effective, can have serious side effects. Authors Ulf Andersson and Kevin J. Tracey describe a circuit between the immune system and the nervous system that enabled development of an implanted nerve stimulator to treat the disorder, now being tested by a patient in Bosnia. If further clinical trials show as much promise as this initial case, similar devices may be developed for a broad range of inflammation-related diseases, from diabetes to congestive heart failure.

Figure 1

The neural circuitry underlying the inflammatory reflex. Pathogens and other molecules produced during tissue damage stimulate macrophages and other immune cells to produce cytokines. These activate sensory neurons, which send information via the afferent arc of the reflex to the brain. In the brain stem these signals are processed, then relayed to the outgoing neurons in the efferent arc, which travel back to the immune system in the spleen and other organs to suppress cytokine release. The complete inflammatory reflex provides a brake that suppresses the production of cytokines.