Safety and Efficacy Vagal Nerve Stimulation in Patients With Rheumatoid Arthritis

Inclusion Criteria: * Adult-onset rheumatoid arthritis of at least six months duration as defined by the 2010 ACR/EULAR classification criteria (Aletaha, 2010) * Male or female patients, 18-75 years of age, inclusive * Functional status I, II, or III as classified according to the ACR 1991 revised criteria (Hochberg, 1992) * Patients must have active disease as defined by at least 4 active tender or swollen joints and CRP above 0.7 mg/dL, despite at least 3 months of treatment with methotrexate at a dose of up to 25 mg orally per week. * Patients may have been previously treated with TNF antagonists, but must have failed by reason of inadequate safety, intolerance to side effects, or development of antibodies (i.e., secondary failures), and specifically cannot have failed on the basis of primary lack of efficacy * Study amended to add a second cohort of up to 10 patients who have failed both a TNF antagonist and at least one other biological therapy having a non-TNF antagonist mechanism of action Exclusion Criteria: * History of unilateral or bilateral vagotomy * History of recurrent vaso-vagal syncope episodes * Known obstructive sleep apnea * Known history of cardiac rhythm disturbances, atrio-ventricular block of greater than first degree, or cardiac conduction pathway abnormalities other than isolated right bundle branch block or isolated left anterior fascicle block * Significant pharyngeal dysfunction or swallowing difficulties * Pre-existing clinically significant vocal cord damage or hoarseness * Previously implanted electrically active medical devices (e.g., cardiac pacemakers, automatic implantable cardioverter-defibrillators) * Asthma or chronic obstructive pulmonary disease not controlled by medications, or any other disease causing clinically significant dyspnea at time of screening * Active peptic ulcer disease