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Arthritis

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Cannabis for Arthritis

Medical Cannabis and Arthritis

Arthritis is an umbrella term describing any disorder that affects joints and bones. The two main types are osteoarthritis and rheumatoid arthritis. Osteoarthritis (degenerative bone disease) is the most common form of arthritis. Medical cannabis could help reduce arthritic pain and inflammation.

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What is Arthritis?

Osteoarthritis, or degenerative bone disease, is the most common form of arthritis. Osteoarthritis usually forms due to age, other health problems and/or the regular use of other medications, especially corticosteroids. Rheumatoid arthritis is an autoimmune disorder predominantly affecting the hands and/or feet. In rheumatoid arthritis, the body’s immune system attacks healthy bone cells, leading to degeneration. Another type of arthritis is psoriatic arthritis, which affects some people’s joints with the skin condition psoriasis. Osteoporosis is a health condition that weakens bones, making them fragile and more likely to break. It is not a formof arthritis, but the two have some overlaps in that bones and joints are weakened.

Symptoms of any type of arthritis include joint pain, stiffness, swelling, warmth and redness, a decreased range of motion, and sometimes even effects on muscles and other organs. Around 1 in 4 (23.7%, or 58.5 million people) adults in the U.S. have doctor-diagnosed arthritis. Arthritis is more common in women (23.5%) than men (18.1%).

Due to its prevalence and the fact that the U.S. population is aging, arthritis could be said to be one of the most common detriments to quality of life and causes of pain in the U.S. 1 in 5 U.S. adults with arthritis has symptoms of anxiety or depression. It is possible for young people to suffer from a form of autoimmune arthritis, called juvenile idiopathic arthritis (JIA). Symptoms of JIA are similar to rheumatoid arthritis.

old woman holding/massaging her other hand

Brief Summary of Current Treatments

There is no cure for arthritis, but many treatments are available to help slow it down. Following a healthy diet, ensuring an appropriate intake of omega-3 and omega-6 oils, exercise and physiotherapy are first-line treatments. Herbal supplements include turmeric extracts and curcumin.

People living with arthritis treat pain with a mixture of antibiotics, NSAIDs such as ibuprofen, steroids such as prednisone, and disease-modifying anti-rheumatic drugs (DMARDs) such as azathioprine (purine synthesis inhibitor) and chloroquine (IL-1 receptor suppressor and anti-malarial). Steroids may thin the bones and cause osteoporosis with long-term use, so some of the current treatment methods can be a double-edged sword.

How Might Medical Cannabis Help?

A study by Dr. Sheng-Ming Dai of China’s Second Military Medical University found unusually high concentrations of CB2 receptors in the joint tissue of arthritic patients. Cannabidiol (CBD) may help activate the pathway of these CB2 receptors and decrease inflammation. The terpene beta-caryophyllene is a selective agonist of CB2 receptors, alleviating inflammation via this pathway.

Other studies, like those by Dr. Jason McDougall and Melissa O’Brien, show that cannabinoids may help repair joint tissue. Different cannabinoid ratios may be needed for different types of arthritis, and Tetrahydrocannabinol (THC) can help relieve pain and inflammation.

Cannabinoids

Cannabinoid Ratios

  • THC:CBD 1:20
  • THC:CBD 1:18
  • THC:CBD 1:3
  • THC:CBD 1:1

Terpenes and Terpenoids

Terpenes that may be useful for managing arthritis include:

Flavonoids

Flavonoids have many antioxidant and anti-inflammatory properties that could help manage arthritis. These include:

Effective Ways of Taking Medical Cannabis for Arthritis

Routes of Administration

  • Inhalation
  • Sublingual
  • Ingestion
  • Topical
  • Transdermal

Special Formulations

A formula rich in CBD, CBG, CBDA, THCA, linalool, limonene, pinene, and beta-caryophyllene, alongside some THC, may be useful for managing arthritis and arthritic pain. There are anecdotal reports of people finding CBD products like tinctures and topicals helpful for managing arthritis.

Dosing Methods

  • Topicals and salves
  • Transdermal patches
  • Tinctures
  • Edibles
  • Vaporization
  • Inhalers

What are the Pros and Cons of Taking Medical Cannabis for Arthritis?

Potential Pros

  • May help treat arthritic pain associated with inflammatory, nociceptive, and neuropathic pain.
  • Could be an anti-arthritic and help repair old bones.
  • CBD oil may act as an anti-inflammatory and “lubricant” for joints affected by arthritis.
  • Rheumatoid arthritis is an autoimmune disorder, and cannabinoids may be able to help dampen an overactive immune system due to their immunomodulatory effects.

Potential Cons

  • No definitive proof of efficacy yet; cannabinoids may be effective for some arthritic patients, but not all, and evidence is primarily anecdotal or studies with small population samples.
  • More research is needed to look at what types of arthritis can be treated with cannabis – some indications that osteoarthritis requires a different treatment than rheumatoid arthritis.

Useful Anecdotal Information

Presentation by Dr. Jason McDougall. “Medical Cannabis: What people with arthritis need to know.” Arthritis Society, Jul. 7 2015

CBD guidelines for arthritis.” Local 4, WDIV. Sep. 24 2019.

Scientific Data Overview and Studies

  • Total Studies = 63
  • Positive Studies = 58
  • Inconclusive Studies = 5
  • Negative Studies = 0
  • 42 Meta-Analyses (39 positive, 3 inconclusive); 12 Animal Studies (11 positive, 1 inconclusive); 2 Double-Blind Human Trials (1 positive, 1 inconclusive); 7 Lab Studies (all positive)
  • 23 studies include CBD (21 positive, 2 inconclusive); 17 studies include THC (15 positive, 2 inconclusive); 1 study includes CBC (positive); 2 studies include CBG(both positive); 1 study includes CBDA (positive); 1 study includes THCA (positive); 5 studies include a CBD:THC ratio of 1:1 (all positive)
  • Total No. of Leafwell Patients = 410
  • Possible Overall Efficacy: High

Quotes from Studies

“Natural phytocannabinoids and synthetic derivatives have produced clear activity in a variety of models of joint pain in animals. These effects are the result of both inhibition of pain pathway signalling (mostly CB1) and anti-inflammatory effects (mostly CB2). There are also numerous anecdotal reports of the effectiveness of smoking cannabis for joint pain. Indeed, it is the largest medical request for the use of the drug. However, these reports generally do not extend to regulated clinical trials for rheumatic diseases. Nevertheless, the preclinical and human data that do exist indicate that the use of cannabis should be taken seriously as a potential treatment of joint pain.”

Source: Miller RJ, Miller RE. “Is cannabis an effective treatment for joint pain?Clin. Exp. Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):59-67. Epub 2017 Sep 28. PMID: 28967368.

“For people living with chronic pain, the options for medication to assist with pain management are limited, and each has its drawbacks. For these people, medical cannabis offers a potential alternative to traditional pharmaceuticals such as NSAIDs, acetaminophen and opioids.” Source: “Medical Cannabis.” The Arthritis Society.

Conclusion

Arthritis is already a burgeoning health problem, and this will likely increase in the future as the population ages. More people must manage arthritic pain and associated issues like insomnia, anxiety, and depression. Medical cannabis and CBD products could be ideal, helping provide an alternative to stronger medications and potentially even reversing bone loss associated with arthritis and osteoporosis.

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Rheumatoid Arthritis and Medical Cannabis

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Osteoporosis and Arthritis

Please note: the information in this article does not constitute medical advice

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Animal Study

19

Clinical Meta-analysis

2

Double Blind Human Trial

2

Human Trial

4

Laboratory Study

5

Meta-analysis

33

Total studies

Arthritis

65

Positive

53 studies

82%

Inconclusive

9 studies

14%

Negative

3 studies

5%

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