Symptomatic and Ultrasonographic Improvement in Rheumatoid Arthritis Temporally Associated with Intravenous NAD+ Therapy: A Case Report.

BACKGROUND: Altered NAD+ metabolism has been described in rheumatoid arthritis (RA), but intravenous NAD+ has not been clinically evaluated for inflammatory arthritis. CASE PRESENTATION: A 49-year-old woman with a rheumatologist-documented diagnosis of RA had progressive polyarthralgia, intermittent swelling, marked morning stiffness, and baseline hand and wrist ultrasonography showing active synovitis. After approximately 4 months of inconsistently taken methotrexate, discontinued because of adverse effects, she received four intravenous NAD+ infusions for aesthetic and antiaging purposes: 250 mg in 500 mL of 0.9% sodium chloride over approximately 1 hour every 2 weeks. She reported rapid pain relief after individual infusions and subsequent improvement in swelling, morning mobility, function, and analgesic use. No infusion-related adverse events were reported. Nine months later, follow-up ultrasonography showed no synovitis or Doppler hyperemia. Psychologic support, exercise, and improvement in personal circumstances occurred concurrently. CONCLUSION: The symptomatic and ultrasonographic changes were temporally associated with intravenous NAD+, but incomplete diagnostic documentation, previous methotrexate exposure, concurrent psychosocial changes, and the uncontrolled retrospective design preclude causal inference. This case is hypothesis-generating and supports prospective controlled investigation.