Acupuncture may reduce increased risk of stroke associated with rheumatoid arthritis

Acupuncture may reduce the increased risk of stroke associated with rheumatoid arthritis, according to a controlled study published in an open access journal. BMJ Open.

The study’s findings showed that the effects appeared to be independent of gender, age, medications, or comorbidities, and the researchers suggested that the treatment may reduce the body’s levels of pro-inflammatory proteins (cytokines) that are associated with cardiovascular disease.

The leading cause of death in people with rheumatoid arthritis is cardiovascular disease, and people with rheumatoid arthritis are also more likely to suffer a stroke than the general population, the researchers note.

Acupuncture is already used to control pain and reduce inflammation, and the researchers wanted to find out whether it could also reduce the risk of ischemic stroke, which is caused by blood clots in the brain that are linked to systemic inflammation.

The researchers used national medical records of 47,809 adults with newly diagnosed rheumatoid arthritis between 1997 and 2010 from the Registry of Patients with Serious Diseases (RCIPD).

The final analysis included 23,226 patients with complete data, of whom 12,266 received acupuncture treatment by the end of December 2010 after diagnosis.

Of these, 11,613 were matched with patients who did not receive acupuncture for age, sex, comorbidities (diabetes, hypertension, high blood lipids, congestive heart failure, anxiety/depression, obesity, atrial fibrillation, alcoholism, smoking), medication use (nonsteroidal anti-inflammatory drugs, statins, disease-modifying drugs), and year of diagnosis.

In both groups, the majority of participants were female, between 40 and 59 years old, and had high blood pressure.

Most of the acupuncture group (87%) received manual acupuncture, 3% received electroacupuncture, in which electrodes that deliver low-current pulses are attached to the needles, and 10% received both treatments.

On average, 1,065 days passed between the diagnosis of RA and the first acupuncture treatment, with the average total number of treatments being approximately 10.

During the monitoring period up to the end of 2011, 946 patients suffered an ischemic stroke. Not surprisingly, the risk increased with increasing age and number of comorbidities.

For example, people with high blood pressure are more than twice as likely to suffer a stroke as people with normal blood pressure, and people with diabetes are 58% more likely.

However, there were significantly fewer cases of ischemic stroke in the acupuncture group, 341 versus 605, a 43% reduction in risk, regardless of age, sex, medication, or comorbidities.

Because this was an observational study, no firm conclusions about causation could be drawn, and the researchers acknowledged that they could only estimate the severity of the disease from the medications patients took.

There was also no information on potentially influencing factors such as height, weight, laboratory tests or physical activity levels, and not everyone would have had the acupuncture applied to the same acupressure points, the researchers added.

“Inflammation is a consistent and independent predictor of cardiovascular disease. [rheumatoid arthritis]The researchers therefore suggest that acupuncture may lower pro-inflammatory proteins and thereby reduce the risk of cardiovascular disease, including ischemic stroke.

“Unstable blood pressure and lipid profile are two risk factors for ischemic stroke, and acupuncture has the advantage of controlling both hypertension and dyslipidemia,” the researchers explained, adding: “If acupuncture reduces morning stiffness and joint pain, patients may benefit from increasing their daily activity, which may also reduce their risk of stroke.”