Reumatizam, Vol. 63 No. 2, 2016.
Original scientific paper
VAGAL NERVE STIMULATION IN THE TREATMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS – RESULTS THROUGH DAY 84 OBTAINED AT THE CROATIAN CENTER OF AN INTERNATIONAL PILOT STUDY
Ines Doko
Simeon Grazio
Frane Grubišić
Ralph Zitnik
Abstract
Electrical stimulation of the vagus has proven eff ective in various infl ammatory conditions in animal
models. Th e aim of this study is to show the eff ect of vagal nerve neurostimulation on clinical and laboratory parameters
in two patients with active rheumatoid arthritis (RA) and an inadequate response to methotrexate.
Patients and methods. Th e research was conducted as part of an international pilot study. Patients were implanted
with the Cyberonics system for electrical stimulation of the vagus. Aft er an initial in-clinic stimulation, the patients
performed the stimulations at home for 42 days, when the device was inactivated. On day 56 the stimulations were
reinitiated. Th e following parameters were evaluated: tender and swollen joint count, physician’s (PGA) and patient’s
(PtGA) global score, intensity of pain, disease activity (DAS28), functional ability (HAQ), serum CRP level, and EULAR
response.
Results. In the period from the screening visit to the day 42 visit, both patients experienced an improvement of
DAS28 (7.00 and 6.22 vs. 4.03 and 2.13), PGA (70 and 53 vs. 27 and 16), PtGA (48 and 43 vs. 15 and 14), tender joint
count (26 and 28 vs. 4 and 0), swollen joint count (24 and 14 vs. 8 and 2), intensity of pain (72 and 87 vs 21 and 7), HAQ
score (2.25 and 2.25 vs. 1.5 and 1.375), and CRP levels (23.8 and 5.58 vs. 13 and 4.61). Aft er the device deactivation,
DAS28 and VAS pain worsened in both patients.
Conclusion. Vagal neural stimulation in the treatment of patients with active RA and an inadequate response to
methotrexate is eff ective in reducing clinical symptoms and parameters of infl ammation. Our results are in accordance
with the results obtained in other centers. Research on a larger number of subjects is necessary for a better evaluation
of the eff ect of this new approach to the treatment of patients with rheumatoid arthritis.
Keywords
Arthritis, rheumatoid – diagnosis, physiopathology, therapy; Vagus nerve stimulation – methods; Severity of illness index; C-reactive protein – analysis; Treatment outcome; Pilot projects
Hrčak ID:
182817
URI
Publication date:
28.12.2016.
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