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Neuromodulation as a Potential Disease-Modifying Therapy for Osteoarthritis

  • Osteoarthritis (MB Goldring and T Griffin, Section Editors)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript


Purpose of Review

The following review discusses the therapeutic potential of targeting the autonomic nervous system (ANS) for osteoarthritis (OA) treatment and encourages the field to consider the candidacy of bioelectronic medicine as a novel OA treatment strategy.

Recent Findings

The study of OA pathogenesis has focused on changes occurring at the joint level. As such, treatments for OA have been aimed at the local joint environment, intending to resolve local inflammation and decrease pain. However, OA pathogenesis has shown to be more than joint wear and tear. Specifically, OA-related peripheral and central sensitization can prompt neuroplastic changes in the nervous system beyond the articular joint. These neuroplastic changes may alter physiologic systems, like the neuroimmune axis. In this way, OA and related comorbidities may share roots in the form of altered neuroimmune communication and autonomic dysfunction.


ANS modulation may be able to modify OA pathogenesis or reduce the impact of OA comorbidities. Moreover, blocking chronic nociceptive drive from the joint may help to prevent maladaptive nervous system plasticity in OA.

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Authors for this publication are supported by the national institute of arthritis and musculoskeletal and skin diseases of the national institutes of health under award number R01AR071431, R01AR071431-S1, the national science foundation under fellowship grant number DGE-1842473, and a graduate student fellowship award from the University of Florida.

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CJC and KDA conceptualized this review. CJC drafted the manuscript, with critical contributions from LSD, KJO, and KDA. All authors approved the final version of the manuscript and figures.

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Correspondence to Kyle D. Allen.

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This article is part of the Topical Collection on Osteoarthritis

Key Points

• Dysfunction of the autonomic nervous system may be a key driver of OA comorbidities and thus may be a critical component of OA’s effects on overall health.

• Vagus nerve stimulation could activate the neuroimmune axis to decrease OA pathogenesis or reduce the risk of OA pathogenesis.

• Blocking chronic OA pain could protect against pathologic shifts in the brain-joint axis and decrease the risk of chronic comorbid disease.

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Cruz, C.J., Dewberry, L.S., Otto, K.J. et al. Neuromodulation as a Potential Disease-Modifying Therapy for Osteoarthritis. Curr Rheumatol Rep 25, 1–11 (2023).

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