Study: Acupuncture could reduce stroke risk in people with rheumatoid arthritis
1 of 2 | Dr. Hung-Rong Yen, a professor and dean of the College of Chinese Medicine at China Medical University, was the lead author of a study that indicated acupuncture might reduce the risk of stroke in those with rheumatoid arthritis. Photo courtesy of China Medical University
People with rheumatoid arthritis have an increased risk of stroke, but a new study indicates that acupuncture could reduce that risk.
The study, conducted by China Medical University in Taiwan, was published Tuesday in the open access journal BMJ Open.
The effects seem to be independent of sex, age, medication use and other existing conditions, prompting researchers to suggest that acupuncture may decrease levels of pro-inflammatory proteins called cytokines, which are linked to cardiovascular disease.
The main cause of death in people with rheumatoid arthritis is cardiovascular disease. And they are more likely to have a stroke than the general population, the study’s researchers noted.
While acupuncture has been used for controlling pain and reducing inflammation, researchers sought to determine if it could lower the risk of ischemic stroke. This type of stroke, caused by a blood clot in the brain, is associated with systemic inflammation.
“Acupuncture has been known as a complementary approach to ameliorate pain. In Taiwan, there are also many patients visiting Chinese medicine clinics for acupuncture treatment,” the study’s lead author, Dr. Hung-Rong Yen, a professor and dean of the College of Chinese Medicine at China Medical University, told UPI via email.
“Our previous study showed that acupuncture was used by 10.9% of Taiwanese people in the general population,” Yen said.
“Among patients with rheumatoid arthritis, 23.6% of them had received acupuncture treatment. It is interesting to know if acupuncture can provide long-term benefits to these patients, not limited to the short-term effect of pain control.”
Possible long-term effect
Yen added that this research reveals the possible long-term effect of acupuncture on stroke prevention. It’s not as expensive as immunosuppressive or biologic medications and should be considered as a standard treatment for rheumatoid arthritis, he said.
Researchers relied on national medical records from the Registry for Catastrophic Illness Patients Database for 47,809 adults newly diagnosed with rheumatoid arthritis between 1997 and 2010.
Yen said these figures represent 99% of the whole population of 23 million in Taiwan with a long-term follow-up period. “With the strength of ‘big data’ and ‘real-world evidence,’ we were able to determine the effectiveness of acupuncture,” he said.
The final analysis included 23,226 patients with complete data, 12,266 of whom received acupuncture after their diagnosis and up until the end of December 2010.
Of these patients, 11,613 were each matched for age, sex, co-existing conditions, medication use ad disease-modifying therapies, as well as year of diagnosis, with a patient who hadn’t received acupuncture.
Women, those aged 40 to 59 and participants with high blood pressure dominated both groups.
Mostly manual acupuncture
Most (87%) of those in the acupuncture group were treated with manual acupuncture (87%); 3% were treated with electroacupuncture, in which an electrode producing a low pulse of electricity is attached to the needle; and 10% received both types.
On average, 1,065 days elapsed between a rheumatoid arthritis diagnosis and the first acupuncture treatment, with the number of sessions averaging about 10.
During the monitoring period up to the end of 2011, 946 patients had an ischemic stroke. Risk increased with 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% more likely to do so.
But there were significantly fewer cases of ischemic stroke among the acupuncture group: 341 versus 605, equivalent to a 43% lower risk. And this was independent of age, sex, medication use and co-existing conditions.
This was an observational study, so no firm conclusions could be drawn about cause and effect, the authors acknowledged. In addition, they could only estimate disease severity from the drugs patients took.
They also lacked information on potentially influential factors, such as height, weight, lab tests or physical activity levels, and not every patient would have had needling of the same pressure points.
Lifestyle factors
“It’s important to consider other lifestyle factors, such as diet and exercise, as well as proper medication management, when addressing cardiovascular risk in these patients,” said Dr. Chiti Parikh, executive director of the Integrative Health and Wellbeing Program at Weill Cornell Medicine and NewYork-Presbyterian, who was not involved in the research.
However, Parikh added that acupuncture is safe and can offer more options for patients with rheumatoid arthritis, particularly those who experience daily stiffness and joint pain, but can’t tolerate certain medications.
“By reducing inflammation, acupuncture can alleviate these symptoms, improving their quality of life and ability to engage in exercise,” she said.
Jacob Wolf, a naturopathic doctor and licensed acupuncturist at University Hospitals Connor Whole Health in Cleveland, said that “rheumatoid arthritis is a systemwide inflammatory condition.”
He added that “while often the main focus symptomatically is on the joints, there are underlying inflammatory processes that can also challenge the cardiovascular system.”
Given the minimal risk that acupuncture poses, Dr. John Magaldi, chief of rheumatology at Hartford HealthCare’s Bone & Joint Institute in Hartford, Conn., said he wouldn’t discourage patients from pursuing it, but he can’t claim that it will reduce the risk of ischemic stroke.
Medications effective
This type of stroke is more associated with high blood pressure and high cholesterol than inflammation. Medicines for these conditions “have led to a tremendous reduction in heart disease and strokes,” Magaldi said.
Dr. Shaiba Ansari-Ali, a rheumatologist at Northwestern Medicine Delnor Hospital in Geneva, Ill., said that “the link between stroke and rheumatoid arthritis is not just plausible, but probable.”
When used as an adjunct to standard medical treatment for rheumatoid arthritis, acupuncture can help calm an overactive immune system, but Ansari-Ali noted that treating the underlying disease still is important to avoid permanent damage and long-term complications.
“Acupuncture is a practice that has been utilized for several thousand years and provides a safe and less invasive method to help modify some diseases,” said Dr. Gary Soffer, physician lead of the Integrative Medicine Program at Yale Medicine’s Smilow Cancer Center in New Haven, Conn.
“Despite being practiced for millennia, there is only a small body of research and limited understanding of how it actually works,” Soffer said. “That is why a study of this scale gets many of us in the integrative medicine community very excited.”