Safety of Splenic Stimulation for RA

Inclusion Criteria: * Adult-onset RA of at least six months duration * Male or female participants, 22-75 years of age * Active RA * Inadequate Response to at least 2 biologic DMARDs and/or JAK- inhibitors (JAKis) * Have an appropriate washout from previously used biological DMARDs or JAKi * A female participant should have no child-bearing potential Exclusion Criteria: * Inability to provide informed consent. * Significant psychiatric disease or substance abuse. * History of unilateral or bilateral vagotomy. * Active or latent tuberculosis * Known infection with human immunodeficiency virus (HIV); current acute or chronic hepatitis B or hepatitis C; previous hepatitis B. * Currently implanted electrically active medical devices (e.g., cardiac pacemakers, automatic implantable cardioverter-defibrillators). * Previous splenectomy * Any investigational small molecule drug or biological within 2 weeks or 2 half-lives whichever is longer, before surgery. * Uncontrolled other inflammatory diseases * Current/recurrent infections that in the opinion of the PI risk\>benefit. * History of cancer within the past 5 years, except non-malignant skin cancer. * Chronic use of morphine or oxicodone