Acupuncture may curb a heightened risk of stroke associated with rheumatoid arthritis

Manual acupuncture was commonly given

Dr Huang and colleagues drew on national medical records from the Registry for Catastrophic Illness Patients Database (RCIPD), for 47,809 adults newly diagnosed with rheumatoid arthritis between 1997 and 2010. The final analysis included 23,226 patients with complete data, 12,266 of whom were treated with acupuncture following their diagnosis up until the end of December 2010.

Of these, 11,613 were each matched for age, sex, co-existing conditions – diabetes, high blood pressure, high blood fats, congestive heart failure, anxiety/depression, obesity, atrial fibrillation, alcohol dependency, and smoking – medication use – non-steroidal anti-inflammatory drugs, statins, and disease modifying drugs – and year of diagnosis with a patient who hadn’t been treated with acupuncture.

Women, those aged 40–59, and participants with high blood pressure predominated in both groups. Most (87 per cent) of those in the acupuncture group were treated with manual acupuncture (87 per cent); three per cent were treated with electroacupuncture, whereby an electrode producing a low pulse of electricity is attached to the needle; and 10 per cent received both types.

Average course of about 10 treatments

On average, 1,065 days elapsed between a rheumatoid arthritis diagnosis and receipt of the first acupuncture treatment, with the number of treatments averaging about 10 in total.

During the monitoring period up to the end of 2011, 946 patients had an ischaemic stroke. Unsurprisingly, risk rose in tandem with increasing age, and with the number of co-existing conditions. Those with high blood pressure, for example, were more than twice as likely to have a stroke as those with normal blood pressure, while those with diabetes were 58 per cent more likely to do so. 

But there were significantly fewer cases of ischaemic stroke among the acupuncture group: 341 vs 605, equivalent to a 43 per cent lower risk. And this was independent of age, sex, medication use, and co-existing conditions.

As the study was observational in nature, no firm conclusions can be drawn about cause and effect, and the researchers also acknowledge that they were only able to estimate disease severity from the drugs the patients took. 

If acupuncture relieves morning stiffness and joint pain, patients might also benefit from increasing daily activities, which might also reduce the risk of stroke [Chia-Yu Huang et al]

Nor did they have information on potentially influential factors, such as height, weight, lab tests or physical activity levels, and not everyone would have had the same pressure points needled, they add.

But Dr Huang and colleagues point out: ‘Inflammation is a consistent and independent predictor of cardiovascular disease in [rheumatoid arthritis],’ so acupuncture may lower pro-inflammatory proteins, thereby reducing the risk of cardiovascular disease, including ischaemic stroke, they suggest.

‘Unstable blood pressure and lipid profiles are the two risk factors for ischaemic stroke, and acupuncture therapy has the advantage of controlling both hypertension and dyslipidaemia,’ they explain, adding: ‘If acupuncture relieves morning stiffness and joint pain, patients might also benefit from increasing daily activities, which might also reduce the risk of stroke.’

To read the full version of the article – titled Effect of acupuncture on ischaemic stroke in patients with rheumatoid arthritis: a nationwide propensity score-matched study doi: 10.1136/bmjopen-2023-075218 – click