Acupuncture may reduce increased risk of stroke associated with rheumatoid arthritis

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

The effects appear to be independent of sex, age, drug use and coexisting conditions, the findings show, prompting researchers to suggest that the procedure may reduce levels of pro-inflammatory proteins (cytokines) in the body which are linked to cardiovascular disease.

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

Acupuncture is already used to control pain and reduce inflammation, and researchers wanted to know if it could also reduce the risk of ischemic stroke (caused by a blood clot in the brain) associated with systemic inflammation.

They relied on national medical records from the Registry of Catastrophic Illness Patients (RCIPD), covering 47,809 adults newly diagnosed with rheumatoid arthritis between 1997 and 2010.

The final analysis included 23,226 patients with complete data, of whom 12,266 were treated with acupuncture after their diagnosis until the end of December 2010.

Of these, 11,613 were matched based on age, gender, coexisting conditions – diabetes, high blood pressure, high blood fat, congestive heart failure, anxiety/depression, obesity, atrial fibrillation, addiction to alcohol and smoking – medication use – no. -steroidal anti-inflammatories, statins and disease-modifying drugs – and year of diagnosis in a patient who had not been treated with acupuncture.

Women, those aged 40 to 59, and participants with high blood pressure predominated in both groups.

Most (87%) people in the acupuncture group were treated with manual acupuncture (87%); 3% were treated with electroacupuncture, where an electrode producing a weak electrical pulse is attached to the needle; and 10% received both types.

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

During the surveillance period until the end of 2011, 946 patients had an ischemic stroke. Unsurprisingly, the risk increases with age and the number of coexisting pathologies.

People 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% more likely.

However, there were significantly fewer cases of ischemic stroke in the acupuncture group: 341 versus 605, equating to a 43% lower risk. This was independent of age, sex, medication use, and coexisting conditions.

This is an observational study and as such no definitive conclusions can be drawn about cause and effect. The researchers also acknowledge that they were only able to estimate the severity of the disease based on the medications taken by the patients.

They also did not have information on potentially influencing factors, such as height, weight, laboratory tests or physical activity levels, and not everyone would have experienced the same pressure points, they add.

“Inflammation is a consistent and independent predictor of cardiovascular disease in rheumatoid arthritis,” so acupuncture could reduce pro-inflammatory proteins, thereby reducing the risk of cardiovascular disease, including ischemic stroke, they suggest.

“Unstable blood pressure and lipid profile are both risk factors for ischemic stroke, and acupuncture treatment has the advantage of controlling both hypertension and dyslipidemia,” they explain, adding: “If acupuncture relieves morning stiffness and joint pain, patients might also benefit from increasing daily activities, which could also reduce the risk of stroke.