The Vagus Nerve, Autoimmune Disease, and What Yoga Therapy Has Been Saying All Along
A pivotal clinical trial published in Nature Medicine earlier this year is drawing significant attention in the rheumatology world — and it has direct relevance to the work being done in yoga therapy with autoimmune and rheumatic conditions, including scleroderma.
The RESET-RA trial examined the use of an implantable device that stimulates the vagus nerve in people with moderately to severely active rheumatoid arthritis who had not responded adequately to biologic or targeted synthetic DMARDs. Across 242 participants, active vagus nerve stimulation demonstrated clinical benefits and was found to be safe over a 12-month period. The findings were highlighted in Nature Reviews Rheumatology by Sarah Onuora (2026), and the full trial was published by Tesser and colleagues in Nature Medicine (vol. 32, pp. 369–378, 2026).
The mechanism at the center of this research is neuroimmune modulation — the idea that the nervous system and the immune system are in ongoing conversation, and that influencing one can meaningfully affect the other. The vagus nerve is a primary pathway in that relationship. It carries signals between the brain and the body’s organs, plays a central role in regulating the inflammatory response, and is a key driver of parasympathetic nervous system activity. When vagal tone is low, inflammatory processes tend to be less regulated. When vagal tone is supported, the body has more capacity to modulate its own immune activity.
This is not a new idea in yoga therapy. Breath-based practices, slow rhythmic movement, sound, and specific relaxation techniques have long been understood to support vagal tone. The mechanisms underlying these practices — reduced sympathetic activation, increased heart rate variability, downregulation of pro-inflammatory pathways — are the same mechanisms now being targeted with implantable neuromodulation devices in clinical trials for rheumatoid arthritis.
For those of us working with scleroderma specifically, this research matters for several reasons. Systemic sclerosis involves significant dysregulation of the autonomic nervous system alongside its fibrotic and vascular processes. Reduced vagal tone and elevated sympathetic activity have been documented in this population and are associated with GI dysmotility, Raynaud’s phenomenon, and broader disease burden. The vagus nerve does not reverse fibrotic tissue changes — nothing does — but supporting the nervous system’s regulatory capacity is a meaningful and underexplored part of managing this disease.
The RESET-RA trial used an implanted device. Yoga therapy uses breath and movement. These are not equivalent interventions, and it is important to be precise about that distinction. What they share is the target: the vagus nerve and its role in modulating the body’s inflammatory and regulatory processes. The emerging body of neuroimmunology research lends scientific grounding to what yoga therapists have been applying clinically for decades.
This is part of why the work presented at this summer’s conferences — including the poster on yoga therapy for digestion in scleroderma submitted to SYTAR 2026 and the presentation at the National Scleroderma Foundation conference in July — matters beyond its immediate clinical audience. The conversation between yoga therapy and mainstream rheumatology research is becoming more possible, and more necessary.
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Citation for reference: Onuora, S. (2026). Vagus nerve stimulation shows clinical benefits for RA in pivotal trial. Nature Reviews Rheumatology, 22, 148. https://doi.org/10.1038/s41584-026-01359-5
Tesser, J. R. P. et al. (2026). Vagus nerve-mediated neuroimmune modulation for rheumatoid arthritis: a pivotal randomized controlled trial. Nature Medicine, 32, 369–378.