This prospective single-center interventional study aims to investigate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) on disease activity, pain, quality of life, autonomic dysfunction symptoms, and inflammatory biomarkers in patients with psoriatic arthritis (PsA). Participants diagnosed with PsA according to the Classification Criteria for Psoriatic Arthritis (CASPAR) will undergo non-invasive auricular vagus nerve stimulation using the Vagustim device. Clinical outcomes including the Disease Activity Index for Psoriatic Arthritis (DAPSA), Ankylosing Spondylitis Disease Activity Score based on C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), pain scores, sleep quality, quality of life, anxiety/depression, and inflammatory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) will be evaluated before and after treatment.
Psoriatic arthritis (PsA) is a chronic, immune-mediated inflammatory disease characterized by heterogeneous clinical manifestations including peripheral arthritis, spondylitis, enthesitis, and dactylitis. Although currently available pharmacological therapies such as conventional synthetic disease-modifying antirheumatic drugs (DMARDs), biologic DMARDs, and targeted synthetic DMARDs are effective in many patients, treatment response may vary, and long-term use may be associated with adverse effects, infection risk, high cost, and treatment resistance. Recent neuroimmunology studies have demonstrated that the vagus nerve plays a significant role in modulation of inflammatory responses through the cholinergic anti-inflammatory pathway. Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation technique targeting the auricular branch of the vagus nerve and has emerged as a potentially safe and reproducible therapeutic approach in inflammatory disorders. Previous studies have shown that vagus nerve stimulation may reduce inflammatory cytokine production and improve clinical outcomes in diseases such as rheumatoid arthritis and systemic lupus erythematosus. However, evidence regarding the clinical and biological effects of taVNS in patients with psoriatic arthritis remains limited. The aim of this prospective, single-center, single-arm interventional study is to evaluate the effects of taVNS on disease activity, pain, functional status, quality of life, autonomic dysfunction symptoms, sleep quality, anxiety/depression symptoms, and inflammatory biomarkers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in patients with PsA diagnosed according to the Classification Criteria for Psoriatic Arthritis (CASPAR). Eligible participants aged 18-65 years with moderate-to-severe disease activity will undergo non-invasive auricular vagus nerve stimulation using the Vagustim device. Electrodes will be placed on the tragus and cymba conchae regions of the auricle, and electrical stimulation will be applied for 20 minutes per session according to predefined stimulation parameters. Clinical assessments including the Disease Activity Index for Psoriatic Arthritis (DAPSA), Ankylosing Spondylitis Disease Activity Score based on C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analog Scale (VAS) pain scores, the Short Form-12 Health Survey (SF-12), Pittsburgh Sleep Quality Index (PSQI), Composite Autonomic Symptom Score-31 (COMPASS-31), Hospital Anxiety and Depression Scale (HADS), and Fibromyalgia Rapid Screening Tool (FiRST) will be evaluated before and after treatment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
15
Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) will be administered using the Vagustim device. Electrodes will be placed on the tragus and cymba conchae regions of the auricle, which are anatomically associated with the auricular branch of the vagus nerve. Electrical stimulation will be applied for 20 minutes per session over a 10-day treatment period while participants are in a seated position. All procedures will be performed according to standardized stimulation parameters and patient safety protocols.
Marmara University Pendik Training and Research Hospital
Istanbul, Turkey (Türkiye)
RECRUITINGChange in Disease Activity According to Disease Activity Index for Psoriatic Arthritis (DAPSA)
Disease activity will be assessed using the Disease Activity Index for Psoriatic Arthritis (DAPSA). Higher scores indicate greater disease activity and worse clinical status.
Time frame: Baseline, Day 10, and Month 3
Change in Disease Activity According to Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
Disease activity and symptom severity will be assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Scores range from 0 to 10, with higher scores indicating greater disease activity and symptom burden.
Time frame: Baseline, Day 10, and Month 3
Change in Disease Activity According to Ankylosing Spondylitis Disease Activity Score Based on C-Reactive Protein (ASDAS-CRP)
Disease activity will be evaluated using the Ankylosing Spondylitis Disease Activity Score based on C-reactive protein (ASDAS-CRP). Higher scores indicate greater inflammatory disease activity and worse clinical status.
Time frame: Baseline, Day 10, and Month 3
Change in Pain Severity According to Visual Analog Scale (VAS)
Pain severity will be assessed using the Visual Analog Scale (VAS), a validated self-reported measure in which participants rate their pain intensity on a scale ranging from 0 (no pain) to 10 (worst imaginable pain).
Time frame: Baseline, Day 10, and Month 3
Change in Global Disease Assessment According to Visual Analog Scale Global Assessment (VAS Global)
Participants' overall perception of disease activity will be assessed using the Visual Analog Scale Global Assessment (VAS Global), scored from 0 to 10. Higher scores indicate greater perceived disease activity and worse health status.
Time frame: Baseline, Day 10, and Month 3
Change in Disease Activity According to Physician Global Assessment (PGA)
Overall disease activity will be evaluated using the Physician Global Assessment, scored from 0 to 10. Higher scores indicate greater disease activity and worse clinical status as assessed by the physician.
Time frame: Baseline, Day 10, and Month 3
Change in Psoriasis Severity According to Psoriasis Area and Severity Index (PASI)
Psoriasis severity and extent of skin involvement will be assessed using the Psoriasis Area and Severity Index (PASI). Scores range from 0 to 72, with higher scores indicating more severe psoriasis and greater skin involvement.
Time frame: Baseline, Day 10, and Month 3
Change in Quality of Life According to Short Form-12 Health Survey (SF-12)
Health-related quality of life will be assessed using the Short Form-12 Health Survey (SF-12). Scores range from 0 to 100, with higher scores indicating better health-related quality of life.
Time frame: Baseline, Day 10, and Month 3
Change in Sleep Quality According to Pittsburgh Sleep Quality Index (PSQI)
Sleep quality and sleep disturbances will be assessed using the Pittsburgh Sleep Quality Index (PSQI). Scores range from 0 to 21, with higher scores indicating poorer sleep quality and greater sleep disturbance.
Time frame: Baseline, Day 10, and Month 3
Change in Autonomic Dysfunction Symptoms According to Composite Autonomic Symptom Score-31 (COMPASS-31)
Autonomic nervous system symptoms will be assessed using the Composite Autonomic Symptom Score-31 (COMPASS-31). Scores range from 0 to 100, with higher scores indicating greater autonomic symptom burden and worse autonomic dysfunction.
Time frame: Baseline, Day 10, and Month 3
Change in Anxiety and Depression Symptoms According to Hospital Anxiety and Depression Scale (HADS)
Symptoms of anxiety and depression will be evaluated using the Hospital Anxiety and Depression Scale (HADS). Total scores range from 0 to 42, with higher scores indicating greater psychological distress.
Time frame: Baseline, Day 10, and Month 3
Change in Fibromyalgia Symptoms According to Fibromyalgia Rapid Screening Tool (FiRST)
Fibromyalgia-related symptoms will be screened using the Fibromyalgia Rapid Screening Tool (FiRST). Scores range from 0 to 6, with higher scores indicating a greater likelihood of fibromyalgia.
Time frame: Baseline, Day 10, and Month 3
Change in C-Reactive Protein (CRP) Level
Inflammatory activity will be evaluated by measuring serum C-reactive protein (CRP) levels. Higher values indicate greater systemic inflammation.
Time frame: Baseline, Day 10, and Month 3
Achievement of Minimal Disease Activity (MDA)
Minimal Disease Activity (MDA) status will be assessed as a composite outcome according to established Psoriatic Arthritis Minimal Disease Activity criteria. Participants will be classified as achieving or not achieving MDA at each assessment time point.
Time frame: Baseline, Day 10, and Month 3
Change in Functional Status According to Health Assessment Questionnaire (HAQ)
Functional disability and daily living activities will be evaluated using the Health Assessment Questionnaire (HAQ). Scores range from 0 to 3, with higher scores indicating greater functional impairment and disability.
Time frame: Baseline, Day 10, and Month 3
Change in Erythrocyte Sedimentation Rate (ESR)
Inflammatory activity will be evaluated by measuring erythrocyte sedimentation rate (ESR). Higher values indicate greater systemic inflammation.
Time frame: Baseline, Day 10, and Month 3
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