INSERM UMRS 938, service de rhumatologie, Sorbonne Université, hôpital Saint-Antoine, AP-HP, Paris, France.
INSERM UMRS 938, service de rhumatologie, Sorbonne Université, hôpital Saint-Antoine, AP-HP, Paris, France.
Joint Bone Spine. 2021 May;88(3):105149. doi: 10.1016/j.jbspin.2021.105149. Epub 2021 Feb 3.
The vagus nerve is the main nerve of the parasympathetic autonomic nervous system. Beyond its vegetative functions, the vagus nerve possesses anti-inflammatory and analgesic properties. Initially developed in the treatment of refractory epilepsy, vagus nerve stimulation (VNS) is currently being evaluated in several musculoskeletal diseases. VNS can be invasive by placing an electrode around the cervical vagus nerve and connected to a generator implanted subcutaneously or non-invasive stimulating the cervical vagus nerve branch percutaneously (auricular or cervical). In rheumatoid arthritis (RA) patients, VNS has been shown to dampen the inflammatory response of circulatory peripheral cells. Several open-labeled small pilot studies have demonstrated that VNS, either invasive or transcutaneous, is associated with a significant decrease of RA disease activity. As well, other studies have shown that VNS could limit fatigue in Sjogren's syndrome and systemic lupus, or decrease pain in fibromyalgia as well as in erosive hand osteoarthritis. However, some questions remain, such as the settings of stimulation, the duration of treatment, or the optimal stimulation route. Finally, randomized controlled trials versus sham stimulation with large samples of patients are mandatory to definitively conclude about the efficacy of VNS.
迷走神经是副交感自主神经系统的主要神经。除了其植物性功能外，迷走神经还具有抗炎和镇痛作用。迷走神经刺激（VNS）最初是在治疗难治性癫痫中开发的，目前正在几种肌肉骨骼疾病中进行评估。VNS 可以通过将电极放置在颈部迷走神经周围并连接到皮下植入的发生器来进行有创，或者通过经皮刺激（耳或颈）来进行无创刺激颈部迷走神经分支。在类风湿关节炎（RA）患者中，VNS 已被证明可以抑制循环外周细胞的炎症反应。几项开放性小试点研究表明，有创或经皮 VNS 与 RA 疾病活动度的显著降低有关。此外，其他研究表明，VNS 可以限制干燥综合征和系统性红斑狼疮的疲劳，或减轻纤维肌痛以及侵蚀性手骨关节炎的疼痛。然而，仍存在一些问题，例如刺激的设置、治疗的持续时间或最佳刺激途径。最后，需要进行随机对照试验与假刺激对照，以大样本患者来明确 VNS 的疗效。
