Rheumatologist OnCall

Did you know your vagus nerve controls inflammation in rheumatoid arthritis?
Your vagus nerve — the longest nerve in your body — runs from your brainstem to your gut, and it has a hidden job: it tells your immune cells to calm down through the cholinergic anti-inflammatory pathway. When it fires, it lowers TNF, IL-1, and IL-6 — the exact signals our biologics target. Same destination. No drug.
In the RESET-RA trial (Nature Medicine, 2026), 242 patients who had failed biologics received a small implanted vagus nerve stimulator in the neck. 35% responded at 3 months, climbing to more than 52% at one year — with minimal side effects, mostly from the procedure itself. It's now the first FDA-approved device therapy for moderate-to-severe RA.
One caution: those "ear clip" vagus devices sold online haven't shown the same benefit in RA. The evidence supports the implanted device.
If you have severe RA that's failed multiple biologics, ask your rheumatologist about vagus nerve stimulation. I dedicated a full chapter to the vagus nerve in my book, Thriving With RA.
Comment VAGUS and I'll send you the info.
Book with a board-certified rheumatologist: rheumatologistoncall.com or 650-525-4404.

Your whole life you were told cartilage can't grow back. Stanford just challenged that.

You've probably seen the headlines — "knee surgery optional." Here's the real story, from a rheumatologist.

Stanford researchers found a protein that builds up in aging cartilage and keeps it breaking down. In old mice, they switched that protein off — and the worn cartilage started to grow BACK.
Not scar tissue. Real, functional cartilage.

Then they took human cartilage from actual knee-replacement surgeries, treated it, and it made new cartilage too. Same result.

Now the honest part: this hasn't been tested in a living human knee yet. So the breakthrough isn't "surgery is optional." It's bigger than that — the idea that "worn cartilage is permanent" is finally being questioned.

That's the kind of science that changes how we think about arthritis.

Follow me for more...

💬 Comment KNEE and I'll send you the study.

I became a menopause specialist because I was the woman falling through the cracks.

For 10+ years in internal medicine, I kept seeing the same story: women with autoimmune disease, crushing fatigue, brain fog, joint pain that didn't match their disease markers — sent home with "normal labs" and "it's just stress."

What kept getting missed? Perimenopause.

The hormonal shift touches every organ in a woman's body, including how autoimmune disease behaves.

So I went back and trained in it — adding board certifications in lifestyle medicine, obesity medicine, and menopause. I became the physician I couldn't find: one who connects both worlds.

You shouldn't have to choose between a specialist who ignores your hormones and a menopause doctor who's afraid of your autoimmune disease.
Your symptoms make sense. You just need someone willing to connect the dots.
Dr. Mirela Titianu, MD — NAMS Certified Menopause Practitioner, triple board-certified (Internal Medicine, Obesity Medicine, Lifestyle Medicine). Telehealth in CA, FL, OR.

PROGRAM LINK: rheumatologistoncall.com/womens-hormone