SAT0298 Transcutaneous vagus nerve stimulation in patients with psoriatic arthritis or ankylosing spondylitis
Authors: S.E. Rasmussen, C. Brock, A. Mohr Drewes, M. Pfeiffer Jensen
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Psoriatic arthritis and ankylosing spondylitis are chronic auto-immune diseases characterised by inflammation of both peripheral and spinal joints. The chronic inflammation may lead to impaired functionality and absenteeism from work. It has become increasingly accepted that the vagus nerve plays a pivotal role as a communicator between the immune and nervous systems<sup>1</sup>. Recent studies in similar immune-mediated inflammatory diseases have demonstrated promising anti-inflammatory effect of vagus nerve stimulation<sup>2,3</sup>. <h3>Objectives</h3> We hypothesised that transcutaneous vagus nerve stimulation (t-VNS) would increase the activity of the vagus nerve, and that this enhanced parasympathetic tone would reduce inflammation and disease activity. The aims of this study were to investigate the effects of t-VNS on cardiac vagal tone and disease activity in patients with psoriatic arthritis or ankylosing spondylitis. <h3>Methods</h3> Twenty patients diagnosed with psoriatic arthritis (median disease duration 7.0 years) and 17 patients diagnosed with ankylosing spondylitis (median disease duration 4.5 years) were included in the study. Transcutaneous vagus nerve stimulation for 120 s was performed bilaterally, thrice daily for four days, using a non-invasive handheld device. Cardiac vagal tone, measured on a linear vagal scale (LVS), and disease activity scores were assessed on the 1 st, 2nd and 5th day. <h3>Results</h3> In the ankylosing spondylitis group, cardiac vagal tone was significantly increased 30 min after t-VNS in comparison to baseline (6.46 vs. 6.57. LVS, p&lt;0.05) (figure 1A), accompanied by a significant reduction in heart rate (68.44 vs. 65.37, p&lt;0.01). Transcutaneous vagus nerve stimulation did not change cardiac vagal tone in the psoriatic arthritis group (figure 1C), however, a significant reduction in heart rate 30 min after t-VNS in comparison to baseline was observed (71.26 vs. 68.04, p&lt;0.01). A significant reduction in ASDAS score was demonstrated in the psoriatic arthritis group on both day 2 (2.09 vs. 1.96, p&lt;0.05) and day 5 (2.09 vs. 1.88, p&lt;0.01) (figure 1D). <h3>Conclusions</h3> Transcutaneous vagus nerve stimulation may have an acute effect on cardiac vagal tone and heart rate in patients with ankylosing spondylitis and psoriatic arthritis. The observed effect of t-VNS on ASDAS scores in patients with psoriatic arthritis was not associated with a modulation of cardiac vagal tone. <h3>References</h3> [1] Rasmussen S, et al. Vagal influences in rheumatoid arthritis. Scand. J. Rheumatol2018;47:1–11. [2] Koopman FA, et al. Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proc. Natl. Acad. Sci 2016;113:8284–8289. [3] Bonaz B, et al. Chronic vagus nerve stimulation in Crohn's disease: a 6-month follow-up pilot study. Neurogastroenterol. Motil2016;28:948–953. <h3>Acknowledgements</h3> This project was supported by the Danish Psoriasis Research Fund and the Danish Rheumatism Association. <h3>Disclosure of Interest</h3> None declared