Inclusion Criteria:  Adult-onset RA of at least six months duration Male or female participants, 22-75 years of age Active RA Inadequate Response to at least 2 biologic DMARDs and/or JAK-inhibitors (JAKis) including at least one TNF inhibitor. Have an appropriate washout from previously used biological DMARDs or JAKi Receiving treatment with standard dose(s) of conventional synthetic DMARD(s)  Exclusion Criteria:  Inability to provide informed consent Significant psychiatric disease or substance abuse History of unilateral or bilateral vagotomy Active or latent tuberculosis Known infection with human immunodeficiency virus (HIV); current acute or chronic hepatitis B or hepatitis C; previous hepatitis B Positive SARS COV 2 PCR screening test for COVID-19 infection (at the point of screening for this study) Currently implanted electrically active medical devices (e.g., cardiac pacemakers, automatic implantable cardioverter-defibrillators) Previous splenectomy