Acupuncture Reduces Incidence of Ischemic Stroke in RA

Hung-Rong Yen, MD, PhD

Credit: Loop (Frontiers)

The incidence of ischemic stroke was reduced in patients with rheumatoid arthritis (RA) who received acupuncture treatment, according to a study published in BMJ Open.¹

Stroke is more common in patients with RA compared with the general population and is among the major causes of death for this patient population. Although the prevalence of RA is 460 per 100,000 people globally and only 15.8 per 100,000 people in Asia, the risk of developing ischemic stroke in Asian patients with RA is comparable to White populations (hazard ratio [HR] 1.32 vs 1.29, respectively).²

“Determining the agents to prevent stroke is an essential issue for clinical doctors and patients,” wrote investigator Hung-Rong Yen, MD, PhD, associated with the Department of Chinese Medicine, China Medical University Hospital, in Taichung, Taiwan. “Finding alternative interventions to control RA while lowering complications from treatment itself has become a well-discussed topic.”

The nationwide, population-based, propensity score-matched cohort study used the National Health Insurance Research Database in Taiwan’s Registry for Catastrophic Illness Patients Database (RCIPD) cohort to identify patients with RA diagnosed between January 1, 1997, and December 31, 2010. Patients who received acupuncture treatment were placed into the acupuncture cohort, while patients who did not were in the non-acupuncture cohort.

A Cox regression model adjusted for age, sex, comorbidities, and types of drugs used. The subhazard ratios (SHRs) of ischemic stroke were compared among groups using competing-risks regression models. No differences were observed in the proportions of obesity, tobacco use, and alcoholism between the acupuncture and no-acupuncture groups.

After propensity score matching, a total of 23,226 patients with newly diagnosed RA were grouped 1:1 into the acupuncture (n = 11,613) or no-acupuncture (n = 11,613) cohorts. The basic demographics of patients were comparable across groups, with most patients aged between 40—59 years, most were female, and the most common comorbidity was hypertension (>38%).

In total, 341 patients in the acupuncture group (5.95 per 1000 person-years) and 605 patients in the no-acupuncture cohort (12.4 per 1000 person-years) experienced ischemic stroke (adjusted SHR .57, 95% confidence interval [CI] .50 — .65).

Patients in the acupuncture cohort had a lower cumulative incidence of ischemic stroke (log- rank test, P <.001). In this group, the immortal time, defined as the period from initial diagnosis of RA to index date, was 1065 days and the mean number of acupuncture visits was 9.83. The lower stroke risk was independent of age, sex, comorbidities, and types of drugs used.

Investigators noted limitations including the inability to identify the number and specific affected joints from the data obtained from the Taiwanese database. To combat this, investigators used prescription data to potentially determine the severity of RA. The RCIPD does not provide information on laboratory data, exercise status, height, or weight. To minimize these confounders, investigators used obesity, tobacco use, and alcoholism diagnosis as ways to represent these characteristics and lifestyles. Despite these limitations, this was the first study to demonstrate the benefits of acupuncture therapy for ischemic stroke prevention in this patient population.

“Our study demonstrates that the ischemic stroke risk could be reduced by acupuncture treatment in patients with RA in Taiwan,” investigators concluded. “The possible mechanism may involve reducing proinflammatory cytokines through acupuncture therapy, thereby attenuating cardiovascular disease, including ischemic stroke. The study also offers important ideas for more comprehensive research in the future.”

References

1. ^{Huang C-Y, Huang MC, Liao H-H, et al.Effect of acupuncture on ischaemic stroke in patients with rheumatoid arthritis: a nationwide propensity score- matched study. BMJ Open 2024;14:e075218. doi:10.1136/ bmjopen-2023-075218}
2. ^{Almutairi K, Nossent J, Preen D, et al. The global prevalence of rheumatoid arthritis: a meta- analysis based on a systematic review. Rheumatol Int 2021;41:863–77.}