Stimulated by Huang et al 2023.[1]
RA – rheumatoid arthritis
key to acronyms
RCIPD – Registry for Catastrophic Illness Patients Database
NHIRD – national health insurance research database (Taiwan)
DMARDs – disease modifying anti-rheumatic drugs
aHR – adjusted hazard ratio
CHD – coronary heart disease
I thought this was the first time I had seen one of these large observational cohort studies from Taiwan published in BMJ Open, but on checking my records I see that there was one from the pre-blog era that I managed to scoop into the end of a blog in 2021: Acupuncture for TLE.[2]
This paper follows along the familiar line of the papers I have previously highlighted here, although they do mention a database that is new to me – the RCIPD. It is a part of the NHIRD – a more familiar acronym here. Having just checked a previous post I see that I have already mentioned this database, although from a time when I did not use a list of acronyms at the top of my blogs.
Between 1997 and 2010 the team identified nearly 50k patients with a diagnosis of RA. Of this group, 36 277 were new diagnoses. After excluding patients under 18, those with missing data for age or sex, and those who had already suffered a stroke, they were left with 34 484 patients. Of these, 12 266 had received acupuncture following their RA diagnosis.
Extensive matching of cases (propensity score matching) using the usual characteristics and comorbidities left them with two equal cohorts of 11 613, one of which had had acupuncture.
The outcome of interests was ischaemic stroke, and the team had hypothesised that is steroids and DMARDs can reduce the risk via an anti-inflammatory mechanism, then perhaps acupuncture can also have an effect via a similar mechanism.
The incidence of ischaemic stroke was lower in the acupuncture cohort (aHR 0.57).
I was interested to see that the risk reduction in the acupuncture cohort was similar across all the different subgroups and comorbidities apart from a couple of areas where the absolute numbers of events were low. In particular, acupuncture was associated with a reduced risk in patients taking steroids or DMARDs.
So, just for clarification, the reduced risk of ischaemic stroke associated with acupuncture use was not affected by whether or not the patients with RA had received steroids. This would suggest that if acupuncture reduces the risk of ischaemic stroke, then it may be through a subtly different mechanism from steroids within the umbrella of what we refer to as an anti-inflammatory effect.
RA was the first condition I highlighted as a result of publication of one of these large retrospective cohort studies from Taiwan: CHD incidence in RA and acupuncture. Acupuncture was associated with a 40% reduction in CHD events (aHR 0.60).[3]
Subsequently, I also reported on a reduced risk of type 2 diabetes in patients with RA associated with acupuncture use (aHR 0.73): Risk of T2DM in RA;[4] and also, and reduced risk of developing endometriosis (aHR 0.45): Acupuncture for endometriosis pain 2023.[5]
So, that is 3 possible reasons for choosing to have acupuncture after you are diagnosed with RA. What about other conditions where acupuncture is associated with a reduced risk of stroke? Well, depression, fibromyalgia, and migraine have all been studied, and acupuncture cohorts have demonstrated a risk reduction in all three (aHR 0.49, 0.53, 0.40 respectively).[6–8]
References
1 Huang C-Y, Huang M-C, Liao H-H, et al. Effect of acupuncture on ischaemic stroke in patients with rheumatoid arthritis: a nationwide propensity score-matched study. BMJ Open. 2024;14:e075218.
2 Weng S-W, Liao C-C, Yeh C-C, et al. Risk of epilepsy in stroke patients receiving acupuncture treatment: a nationwide retrospective matched-cohort study. BMJ Open. 2016;6:e010539.
3 Wu M-Y, Huang M-C, Liao H-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with rheumatoid arthritis in Taiwan: a Nationwide propensity score-matched study. BMC Complement Altern Med. 2018;18:341.
4 Chen W-J, Livneh H, Chen C-H, et al. Does Use of Acupuncture Reduce the Risk of Type 2 Diabetes Mellitus in Patients With Rheumatoid Arthritis? Evidence From a Universal Coverage Health Care System. Front Med. 2021;8:752556.
5 Chen W-J, Livneh H, Hsu C-H, et al. The Relationship of Acupuncture Use to the Endometriosis Risk in Females With Rheumatoid Arthritis: Real-World Evidence From Population-Based Health Claims. Front Med. 2020;7:601606.
6 Chen L-Y, Yen H-R, Sun M-F, et al. Acupuncture treatment is associated with a decreased risk of developing stroke in patients with depression: A propensity-score matched cohort study. J Affect Disord. 2019;250:298–306.
7 Huang M, Yen H-R, Lin C, et al. Acupuncture decreased the risk of stroke among patients with fibromyalgia in Taiwan: A nationwide matched cohort study. PLOS ONE. 2020;15:e0239703.
8 Liao C-C, Chien C-H, Shih Y-H, et al. Acupuncture Is Effective at Reducing the Risk of Stroke in Patients with Migraines: A Real-World, Large-Scale Cohort Study with 19-Years of Follow-Up. Int J Environ Res Public Health. 2023;20:1690.
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