Vagus nerve stimulation (VNS) uses gentle electrical signals (via a small implanted device or handheld external stimulator) to activate the vagus nerve. This triggers the body’s anti-inflammatory reflex, reducing cytokine release such as TNF and IL-6. VNS is being explored as a non-drug adjunct to help manage pain, stiffness and flares.
In 2026, expect:
Results from larger RA and psoriatic arthritis trials
Better-designed implanted and non-invasive devices
Increased availability of home-use stimulators
VNS is unlikely to replace DMARDs but may become a helpful complementary therapy
One of the most exciting areas for 2026 is the use of wearable devices plus blood biomarkers to predict flares of autoimmune diseases like rheumatoid arthritis, before symptoms fully declare themselves. Studies using activity trackers and smart watches have shown that changes in steps, heart rate, sleep patterns and other sensor signals can distinguish higher versus lower RA disease activity, and in some cases these changes are detectable days to weeks before a clinical flare.
A key part of this research is heart rate variability (HRV)—the tiny variation in time between each heartbeat. HRV reflects how well the autonomic nervous system (including the vagus nerve) is balancing “fight–flight” and “rest–repair” signals. In practical terms, this means that sudden drops in HRV (especially when combined with changes in resting heart rate, sleep disruption and reduced activity) may be a signal that the immune system is becoming more active, even before joints become obviously swollen or painful.
For patients, this could eventually mean:
More precise, personalised flare warnings delivered via a watch or phone app
The ability to adjust self-management early (rest, stress reduction, medication timing as advised) before a full flare develops
Better conversations in clinic, using shared data from wearables and blood tests to decide when to escalate or taper treatment
These tools are still being validated and are not yet a replacement for medical review, but 2026 is likely to see rapid progress in bringing wearables, HRV and biomarkers together to help anticipate and prevent autoimmune flares rather than just reacting to them.