Rheumatoid Arthritis is a chronic, progressive autoimmune disease of unknown cause. It is characterized by persistent inflammation that primarily affects the peripheral joints. It usually starts as an insidious symmetrical arthritis and has an unpredictable and variable course, although pain and disability can be minimized if the condition is recognized early and treated promptly and appropriately.

Rheumatoid arthritis is the most commonly diagnosed systemic inflammatory arthritis. Women, smokers, and those with a family history of the disease are most often affected. Criteria for diagnosis include having at least one joint with definite swelling that is not explained by another disease. The likelihood of a rheumatoid arthritis diagnosis increases with the number of small joints involved. In a patient with inflammatory arthritis, the presence of a rheumatoid factor or anti-citrullinated protein antibody, or elevated C-reactive protein level or erythrocyte sedimentation rate suggests a diagnosis of rheumatoid arthritis.

Inflammation is a normal response to injury and infection, but too much inflammation can damage tissues. You see this in many diseases, including autoimmune conditions such as rheumatoid arthritis. The nervous system of mammals has therefore evolved mechanisms to control inflammation. 

Imbalance in the autonomic nervous system has been observed in many established chronic autoimmune diseases, including rheumatoid arthritis, which is a prototypic immune-mediated inflammatory disease. Studies have shown promising evidence that therapeutic electrical modulation of the vagus nerve may serve as an alternative, non-pharmacological, neuroimmunomodulatory intervention in RA in the future. In addition, it has been documented the ancient acupuncture treat inflammatory diseases through stimulating vagus nerve.

The inflammatory reflex is a neural circuit that regulates the immune response to injury and invasion. All reflexes have an afferent and efferent arc. The Inflammatory reflex has a sensory, afferent arc, which is activated by cytokines, and a motor, or efferent arc, which transmits action potentials in the vagus nerve to suppress cytokine production. Increased signaling in the efferent arc inhibits inflammation and prevents organ damage.

The mammalian immune system and the nervous system coevolved under the influence of infection and sterile injury. Knowledge of homeostatic mechanisms by which the nervous system controls organ function was originally applied to the cardiovascular, gastrointestinal, musculoskeletal, and other body systems. Development of advanced neurophysiological and immunological techniques recently enabled the study of reflex neural circuits that maintain immunological homeostasis, and are essential for health in mammals.

Reflex neural circuits are the basic organizational units of the nervous system, capable of rapid and precise responses to countless of physiologic challenges in both health and disease. The mammalian nervous system encodes many different forms of pain, from those that arise as a result of short-term low-grade interactions with noxious thermal, chemical, or mechanical sources to more serious forms of pain induced by trauma and disease. And reflex neural circuits encode these types of pain.

Inflammation and immunity are regulated by reflex neural circuits. Recent basic science research has demonstrated that a reflex neural circuits, termed the inflammatory reflex, modulates systemic and regional inflammation. Reflex neural circuits regulate cytokine release to prevent potentially damaging inflammation and maintain homeostasis. In the inflammatory reflex, sensory input elicited by infection or injury travels through the afferent vagus nerve to integrative regions in the brainstem, and efferent nerves carry outbound signals that terminate in the spleen and other tissues. Failure of reflex neural circuits mechanisms in mammals contributes to non-resolving inflammation and disease.

An electrical implant like a pacemaker has been invented by researchers to alleviate the symptoms of diseases such as Crohn’s disease and rheumatoid arthritis by controlling the body’s neural circuits. With this device, patients would no longer need to take any pills.

Rheumatoid arthritis is a crippling autoimmune disease that causes chronic inflammation in joints. Painful swelling can destroy the major and minor joints of the hands, feet, and extremities, leading to disability, fatigue, and immobility. Currently there are no cures for rheumatoid arthritis. The basic problem in rheumatoid arthritis, and other autoimmune diseases, is that immune system cells begin to attack the body’s own tissues. In rheumatoid arthritis, high cytokine levels accumulate in the cartilage and other inflamed joint tissues to produce pain and destroy tissues. One of the major toxic cytokines is termed TNF. Treatments that specifically block the action of cytokines have shown major promise in alleviating the disease in some autoimmune patients. In healthy people, the nervous system provides a precise mechanism of checks and balances that maintains the levels of TNF within a safe range. For unknown reasons, in rheumatoid arthritis these vagus nerve signals fail, and the resulting brake failure causes an excessive production of TNF. Restoring the brakes on inflammation with computerized nerve stimulation is promising. Researchers are studying whether it may be possible to modulate the inflammatory reflex for treating a number of diseases, since the basic mechanisms of dysregulated inflammation also contribute to the pathogenesis of inflammatory bowel disease, congestive heart failure, arthritis, shock, sepsis, and other syndromes.

The clinical effects of acupuncture on pain and inflammation relief have been well documented. Scientific researches have demonstrated that acupuncture activates inhibitory neural circuits for pain and inflammation relief. The action of acupuncture on vagus nerve stimulation has similar mechanisms as the restoring the brakes on inflammation with computerized nerve stimulation.

It is popular now to develop novel treatment for inflammatory diseases, such as neuropathy and neuromuscular diseases, rheumatoid arthritis and other autoimmune disorders, through basic science research and clinical translational research targeting on reflex neural circuits. It is also possible to target these neural pathways using electrical nerve stimulators and pharmacological agents to hasten the resolution of inflammation and provide therapeutic benefit. And acupuncture clinical translational research could explore novel biomarkers as targets for preventive and therapeutic treatment. It is important that a well established and clinically effective acupuncture treatment modality should be used as a clinical study model. RUI acupuncture, the 7th generation acupuncture at Acupuncture Center USA and Arthritis and Pain Treatment Center, is a well established acupuncture treatment that is clinically proven to be effective. Therefore RUI acupuncture is a practical clinical translational research model in order to develop novel biomarkers as targets for therapeutic and preventive treatment.