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) Have an appropriate washout from previously used biological DMARDs or JAKi A female participant should have no child-bearing potential  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. Currently implanted electrically active medical devices (e.g., cardiac pacemakers, automatic implantable cardioverter-defibrillators). Previous splenectomy Any investigational small molecule drug or biological within 2 weeks or 2 half-lives whichever is longer, before surgery. Uncontrolled other inflammatory diseases Current/recurrent infections that in the opinion of the PI risk>benefit. History of cancer within the past 5 years, except non-malignant skin cancer. Chronic use of morphine or oxicodone