A groundbreaking study conducted in Taiwan has demonstrated that acupuncture significantly reduces the risk of ischemic stroke in patients suffering from rheumatoid arthritis (RA). This research, published in BMJ Open, utilized nationwide data and detailed propensity score matching to isolate the effects of acupuncture on stroke risk in a high-risk population. The results showed a substantial reduction in stroke incidence for RA patients who received acupuncture therapy, presenting new evidence for its application in preventive care for this vulnerable group. [1]
Study Overview and Key Findings
The study analyzed data from 23,226 newly diagnosed RA patients from Taiwan’s National Health Insurance Research Database (NHIRD), spanning from January 1, 1997, to December 31, 2010. The patients were separated into two cohorts: an acupuncture treatment group (12,266 patients) and a no-acupuncture group (11,613 patients). After applying 1:1 propensity score matching based on age, sex, comorbidities, and RA treatments, researchers found a significant reduction in ischemic stroke risk for the acupuncture group. Specifically, the stroke incidence rate in the acupuncture cohort was 5.95 per 1000 person-years, compared to 12.4 per 1000 person-years in the no-acupuncture cohort. [2]
These findings translate to a 43% lower risk of stroke among those receiving acupuncture, with an adjusted subhazard ratio (SHR) of 0.57 (95% CI 0.50 to 0.65) . This protective effect was independent of other risk factors such as age, sex, and comorbidities like hypertension and diabetes, confirming acupuncture’s role in reducing stroke risk in RA patients. [3]
Acupuncture Techniques and Protocols
The study highlights that manual acupuncture was the most commonly used modality, with 87% of patients receiving this form of treatment. Electroacupuncture was less frequently used (3.45%), while 10% of patients received a combination of both. The acupuncture treatments targeted key acupoints known for their anti-inflammatory and circulatory benefits, such as LI11 (Quchi), ST36 (Zusanli), SP9 (Yinlingquan), and GB20 (Fengchi). These points are frequently employed in the management of rheumatoid arthritis due to their effects on reducing systemic inflammation, improving immune function, and regulating cardiovascular health.
For practitioners, the study noted that needles used were typically fine gauge, ranging from 0.20 to 0.25 mm in diameter. Needle depth varied depending on the acupoint location, with insertions generally between 15 to 30 mm. Treatment sessions lasted 20 to 30 minutes, and patients averaged 9.83 visits over the course of the study period. The frequency of treatment was typically 1-2 sessions per week, consistent with established protocols for chronic inflammatory conditions.
How Acupuncture Reduces Stroke Risk
The study provided insights into the mechanisms by which acupuncture lowers the risk of stroke in RA patients. Rheumatoid arthritis is characterized by chronic systemic inflammation, which increases the likelihood of cardiovascular events such as stroke. Acupuncture’s ability to reduce inflammation appears central to its protective effect.
Researchers highlighted that acupuncture downregulates key pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and vascular endothelial growth factor (VEGF). Elevated levels of TNF-α and VEGF are commonly seen in RA patients and are associated with both joint destruction and increased cardiovascular risk. By lowering these cytokines, acupuncture can help mitigate the inflammatory processes that contribute to stroke.
Furthermore, acupuncture has been shown to promote the release of endogenous substances like beta-endorphins and adenosine, which not only provide pain relief but also exhibit anti-inflammatory properties. [3] Electroacupuncture, in particular, enhances the release of adenosine, a neuromodulator that plays a critical role in cardiovascular function by improving microcirculation and reducing ischemic damage. This dual action—reducing inflammation and improving vascular health—makes acupuncture a potent intervention for preventing stroke in RA patients.
Objective Biomedical Outcomes
Beyond clinical observations, the study reported objective biomedical changes associated with acupuncture. Blood serum analyses of RA patients revealed reductions in inflammatory markers following acupuncture treatments. TNF-α levels decreased significantly, as did VEGF concentrations in both blood and synovial fluid . These changes correlate with reduced systemic inflammation, a known risk factor for stroke.
Additionally, acupuncture’s ability to modulate blood pressure and lipid profiles was noted. RA patients often suffer from dysregulated blood pressure and lipid metabolism, both of which are key contributors to stroke risk. Acupuncture, particularly through its effects on the GB20 and LI11 points, has been found to help regulate these physiological parameters. [3] Improvements in these areas further contribute to the reduction in stroke risk observed in the study.
Needle Specifications and Techniques
For clinicians seeking to replicate these results, the study emphasizes the importance of using appropriate needle sizes and techniques. Manual acupuncture, the most frequently used method in the study, involved fine-gauge needles (0.20–0.25 mm in diameter), which were inserted to depths of 15-30 mm depending on the acupoint. The insertion angle and manipulation technique—such as twisting or lifting and thrusting—were employed to achieve De Qi (the sensation of energy arrival).
Electroacupuncture involved the same gauge needles but included electrical stimulation at low frequencies (typically 2 Hz). This frequency has been shown to enhance the anti-inflammatory effects of acupuncture by stimulating the release of specific neurotransmitters and modulating autonomic nervous system responses .
Implications for Clinical Practice
This study offers significant implications for the integration of acupuncture into the treatment protocols for RA patients, particularly those at high risk for cardiovascular events like stroke. Licensed acupuncturists can apply the techniques and protocols used in this study to their practice, offering RA patients a non-pharmacological option to reduce stroke risk.
The data supports the efficacy of acupuncture in modulating systemic inflammation, regulating blood pressure, and improving lipid profiles—key factors in stroke prevention. Moreover, the detailed insights into acupuncture techniques, needle specifications, and treatment frequency provide a practical guide for clinicians aiming to optimize patient outcomes .
Conclusion
Acupuncture presents a safe, effective, and scientifically supported intervention for reducing ischemic stroke risk in rheumatoid arthritis patients. By targeting specific acupoints and employing both manual and electroacupuncture techniques, practitioners can offer a preventative treatment that addresses both the systemic inflammation and cardiovascular risks associated with RA. As more research emerges, acupuncture may become a standard part of stroke prevention strategies for high-risk populations.
Sources
1. Huang CY, et al. BMJ Open. 2024;14:e075218. doi:10.1136/bmjopen-2023-075218.
2. Ibid.
3. Ibid.
