In a recent study published in BMJ Open, a group of researchers evaluated the effectiveness of acupuncture in reducing the risk of ischemic stroke among patients with rheumatoid arthritis (RA).
Study: Effect of acupuncture on ischaemic stroke in patients with rheumatoid arthritis: a nationwide propensity scorematched study. Image Credit: Andrey_Popov/Shutterstock.com
Background
RA is a widespread condition characterized by severe joint inflammation and complications like bone erosion and cardiovascular diseases, notably increasing stroke risk. Globally, RA affects 460 per 100,000 people, with a similar stroke risk observed in Asian and Caucasian populations.
Traditional treatments include non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and conventional disease-modifying antirheumatic drugs (DMARDs), which can reduce stroke risk but may cause side effects like thrombocytopenia.
Acupuncture, widely used in various countries for RA and pain management, offers a potential alternative by reducing inflammation and stroke risk, reflecting the importance of exploring non-traditional interventions for RA management.
Further research is necessary to determine the causal relationship between acupuncture and reduced ischemic stroke risk in rheumatoid arthritis patients.
About the study
The present study utilized a comprehensive approach by analyzing data from the National Health Insurance Research Database (NHIRD) of Taiwan, focusing on a specific subset, the Registry for Catastrophic Illness Patient Database (RCIPD), to ensure a broad and detailed examination of RA patients' health outcomes. Personal identifiers were removed to maintain confidentiality.
The ethics committee approved the research, emphasizing its adherence to ethical standards.
By employing a 1:1 propensity score-matched cohort study design, the researchers aimed to minimize biases and confounders in comparing the effects of acupuncture therapy on newly diagnosed RA patients against those who did not receive such treatment.
The selection criteria were carefully defined to include only eligible RA patients, with exclusions for those under 18, lacking complete data, experiencing insurance interruptions, or having prior ischemic stroke diagnoses.
This rigorous methodology facilitated a balanced comparison between acupuncture and no-acupuncture cohorts, using demographic and medical variables to ensure comparability.
The analysis included a thorough assessment of comorbidities and treatments, employing advanced statistical techniques to evaluate the impact of acupuncture on ischemic stroke risk among RA patients, demonstrating a commitment to robust and precise scientific inquiry.
Study results
In the study, researchers utilized a thorough process of 1:1 propensity score matching to compare the outcomes of RA patients who received acupuncture with those who did not.
The matching criteria were extensive, including sex, age, all comorbidities, medications such as oral steroids, NSAIDs, statins, all DMARDs, RA diagnosis year, and index year.
This rigorous approach resulted in the enrollment of an equal number of patients, 11,613 in each cohort, for the acupuncture and no-acupuncture groups.
A close examination of the baseline characteristics, including distributions of sex, age, comorbidities, and prescriptions, revealed striking similarities between the two cohorts. Most participants in both groups were female and middle-aged, aged 40 to 59 years.
Hypertension emerged as the most prevalent comorbidity, affecting over 38% of the patients, while other significant conditions such as hyperlipidemia, congestive heart failure, diabetes mellitus, anxiety, and depression were also noted.
The study found no significant differences in the occurrence of alcoholism, tobacco dependence, or obesity between the cohorts. NSAIDs were the predominant prescription, with 76% of patients taking these medications.
Regarding treatment specifics, 87% of patients received manual acupuncture, 3% underwent electroacupuncture, and the remaining 10% received a combination of both techniques. On average, it took about 1065 days from RA diagnosis to the initiation of the first acupuncture treatment, with an average of 9.83 visits per patient.
Throughout the follow-up period, the study observed that 946 patients developed ischemic stroke. The incidence rate of this condition increased with age, indicating a higher risk for older patients.
The study adjusted subdistribution hazard ratios (SHRs) for various age groups and comorbid conditions, revealing increased risks associated with diabetes mellitus, hypertension, and congestive heart failure.
However, a significant finding of the study was the lower cumulative incidence of ischemic stroke in the acupuncture cohort compared to the no-acupuncture group, highlighting the potential protective effect of acupuncture against ischemic stroke in RA patients.
The analysis further demonstrated that both male and female patients benefited from acupuncture in terms of stroke prevention, with adjusted SHRs indicating reduced risks across different age groups and among those with various comorbidities.
Notably, the positive impact of acupuncture on stroke risk was evident irrespective of the concurrent use of steroids, statins, or DMARDs.
To ensure the reliability of these findings, the researchers also conducted a non-matching analysis, which supported the initial results obtained through propensity score matching.
The study concluded with the affirmation that acupuncture could significantly reduce the risk of ischemic stroke among RA patients, offering valuable insight into the potential benefits of integrating acupuncture into the management of RA.
Study highlights disparities in stroke costs across healthcare services in Latin America