Hung Long Yen, MD, PhD
Credit: Loop (Frontiers)
Rheumatoid arthritis (RA) patients who received acupuncture treatment had a reduced incidence of ischemic stroke, according to a study published today. BMJ Open.1
Stroke is more common in patients with rheumatoid arthritis compared to the general population and is one of the leading causes of death in this patient population. The prevalence of rheumatoid arthritis is 460 per 100,000 people worldwide, but only 15.8 per 100,000 people in Asia, but Asian patients with rheumatoid arthritis have a higher risk of developing ischemic stroke than Caucasian populations. Equivalent (hazard ratio) [HR] 1.32 vs. 1.29, respectively).2
“Determining which drugs will prevent stroke is an essential question for clinicians and patients,” said Fung Long Yen, MD, a researcher at the Department of Traditional Chinese Medicine at China Medical University Hospital in Taichung, Taiwan. writing. “Finding alternative interventions to control rheumatoid arthritis while reducing complications from the treatment itself has become a frequently discussed topic.”
A nationwide population-based propensity score matched cohort study using the National Health Insurance Research Database of Taiwan’s Registration of Patients with Idiopathic Diseases (RCIPD) cohort from January 1, 1997 to December 31, 2010. We identified patients with rheumatoid arthritis diagnosed in . Patients who received acupuncture were classified into the acupuncture cohort, and patients who did not receive acupuncture were classified into the non-acupuncture cohort.
Cox regression model adjusted for age, gender, comorbidities, and type of medication used. Competing risks regression models were used to compare subhazard ratios (SHRs) for ischemic stroke between groups. No differences were observed in the rates of obesity, smoking, or alcoholism between the acupuncture-treated and non-acupuncture-treated groups.
After propensity score matching, a total of 23,226 patients with newly diagnosed rheumatoid arthritis were divided 1:1 into the acupuncture-treated (n = 11,613) or non-acupuncture-treated (n = 11,613) cohorts. Grouped. Baseline patient demographics were similar between groups, with most patients aged 40 to 59 years, mostly women, and the most common comorbidity was hypertension (>38%).
In total, 341 patients (5.95 per 1000 person-years) in the acupuncture group and 605 patients (12.4 per 1000 person-years) in the no-acupuncture cohort experienced an 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 immortality period, defined as the period from the first diagnosis of rheumatoid arthritis to the index date, was 1065 days for him, and the average number of acupuncture sessions was 9.83 for him. The reduction in stroke risk was independent of age, gender, comorbidities, and type of medication used.
The researchers pointed to limitations in the data obtained from the Taiwanese database, including the inability to determine the number or specific joints affected. To combat this, researchers could use prescription data to determine the severity of rheumatoid arthritis. RCIPD does not provide information on laboratory data, athletic status, height, or weight. To minimize these confounding factors, the researchers used diagnoses of obesity, smoking, and alcoholism as a way to represent these characteristics and lifestyles. Despite these limitations, this was the first study to demonstrate the benefits of acupuncture for ischemic stroke prevention in this patient population.
“Our study shows that the risk of ischemic stroke in Taiwanese patients with rheumatoid arthritis can be reduced by acupuncture,” the researchers concluded. “A possible mechanism is that acupuncture-induced reductions in pro-inflammatory cytokines may attenuate cardiovascular disease, including ischemic stroke. This study provides guidance for future more comprehensive studies. It also provides important ideas.”
References
- Huang CY, Huang MC, Liao HH, et al. Effects of acupuncture on ischemic stroke in patients with rheumatoid arthritis: A national propensity score matched study. BMJ Open 2024;14:e075218. doi:10.1136/ bmjopen-2023-075218
- Almutairi K, Noscent J, Prine D, et al. Global prevalence of rheumatoid arthritis: A meta-analysis based on a systematic review. Rheumatol Int 2021;41:863–77.
