For nearly four decades, San Antonio resident Susan Perry struggled to manage the chronic pain from her rheumatoid arthritis, an autoimmune disease that occurs when the immune system mistakenly attacks the body’s tissues and joints.
Perry, now 69, was diagnosed in her early 30s and cycled through over a dozen medications, trying to balance finding relief and managing the side effects from the drugs. At its worst, the chronic inflammation made falling asleep challenging, and Perry required a stool to sit on while volunteering at her church’s kitchen in the Crownridge area just north of Six Flags.
In February, Perry became the first person in Texas to receive a new jelly-bean-sized neuromodulation implant, the first drug-free alternative for some patients with rheumatoid arthritis, known as the SetPoint System. It was approved by the U.S. Food and Drug Administration in July of last year.
The device sits on her vagus nerve, sending electrical pulses and activating anti-inflammatory pathways to restore immune system balance. It has allowed Perry to ditch the stool at her church and sleep pain-free.
“I keep waiting to have some bad days, but I’m not,” Perry said. “I’m still amazed by it.”
Treating rheumatoid arthritis
Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation, pain and swelling and affects roughly 1.3 million Americans.
It disproportionately affects women.
Originally from Indiana, Perry and her family moved to San Antonio in 1988. Perry was diagnosed with rheumatoid arthritis shortly after, following years of unexplained stiffness, pain and fatigue.
“It was pretty scary at that point, being just barely over 30, and not knowing what would happen,” she said.
Doctors were hesitant to start her on medication, which at the time came with more severe side effects. But her flare-ups were becoming more severe. She was struggling to stand up and sit down in chairs and couldn’t play on the floor with her young children.
“I pretty much broke down in the doctor’s office and said, ‘You know, I don’t care if I don’t live as long, I want to live now,’” Perry said.
She cycled through numerous medications over the years, including gold injections, once the go-to treatment for the disease, which have been largely replaced by safer and more effective medications. She has also tried 10 biologics, from a newer class of treatments that block specific parts of the immune system.
Many helped, but side effects and persistent symptoms remained.
“I’ve been through about everything,” Perry said.
The SetPoint implant, approved in July 2025 to treat moderate to severe rheumatoid arthritis, offered a new approach for patients whose symptoms persisted or who couldn’t tolerate the medications’ side effects.
Instead of suppressing the immune system, the device sends mild electrical pulses to the vagus nerve, a major nerve involved in regulating various bodily functions and inflammatory responses.
A different way to target inflammation
Dr. Daniel Peterson, a neurosurgeon at Ascension Medical Group Seton Neurosurgery, performed Perry’s procedure at Dell Seton Medical Center in Austin. He was also involved in the SetPoint clinical trials.
Neuromodulation devices have been around for decades, initially used to reduce the frequency of seizures in patients with drug-resistant epilepsy. Researchers became interested in the vagus nerve after noticing that epilepsy patients who received vagus nerve stimulation also experienced improvements in other conditions they had, like autoimmune conditions, Peterson explained.
“What this device does is stimulate branches of the vagus nerve that influence those inflammatory pathways,” Peterson said. “It doesn’t suppress the immune system, it modulates it back toward normal.”
The implant procedure itself is minimally invasive. Surgeons make a small incision in the left side of the neck and place the jelly-bean-sized device around the vagus nerve. Perry said her surgery lasted about 15 minutes and she was back home before lunch.
“I fixed dinner that night,” she said. “It was the easiest surgery I’ve ever had.”
Patients charge the device wirelessly once a week for about five minutes. Perry’s device activates automatically each morning around 4 a.m. while she sleeps, based on settings programmed by her rheumatology team.
Within weeks of the procedure, Perry said blood tests showed her inflammation levels had dropped significantly.
Dell Seton became the first hospital in Texas to implant the device and one of the earliest sites nationwide to participate in the clinical trial, Peterson said, enrolling 34 patients.
In a randomized clinical trial published earlier this year, researchers reported sustained improvements in disease activity in patients with the device and relatively few adverse events over a year of follow-up. Some patients experienced temporary vocal cord weakness from the surgery that later resolved.
Researchers are preparing clinical trials examining whether similar neuroimmune modulation could help treat diseases such as multiple sclerosis and Crohn’s disease. “There’s very promising preclinical data,” Peterson said.
Still, Peterson said broader adoption for rheumatoid arthritis may depend on insurance coverage and whether rheumatologists become more comfortable referring patients for surgery over drug therapies.
Perry was able to get her surgery covered through Medicare, which approved it for coverage in November.
“The patients are the ones that are ultimately going to drive the adoption,” Peterson said.
