- New Study Suggests Cannabis May Be Effective For Rheumatoid Arthritis, And Why It May Not Matter
- Can Medical Marijuana Help Rheumatoid Arthritis?
- Concerns of Using Cannabis for RA
- Information and Availability Is Limited
- Key Takeaways
- Medical Marijuana For Rheumatoid Arthritis
- What Is Rheumatoid Arthritis?
- Rheumatoid Arthritis Statistics
- What Causes Rheumatoid Arthritis?
- Symptoms and Side Effects of Rheumatoid Arthritis
- Current Treatments Available and Their Side Effects
- How Is Medical Marijuana an Effective Treatment?
- Rheumatoid Arthritis Symptoms Treated by Medical Marijuana
- Methods of Treatment Available
- How to Get Medical Marijuana Treatments
- Information About Medical Marijuana and Rheumatoid Arthritis
New Study Suggests Cannabis May Be Effective For Rheumatoid Arthritis, And Why It May Not Matter
Abbie Rosner: How much of your practice focuses on patients with RA?
Dr. Benjamin Caplan: RA and osteoarthritis are quite prominent in the general population: the lifetime risk of RA in adults is about 3.6 %, with women being at a higher risk. And RA tends to peak between the ages of 50 and 75. They are both common, however in the case of osteoarthritis, it can happen to us all since one of the risk factors is simply the march of time.
In my practice, we see a select slice of the general population, with rates of RA that are closer to 27% in patients over 52, and varying degrees of severity. I have patients with mild joint pain that can be satisfactorily addressed with a topical cannabis treatment. Others are nearly incapacitated, taking multiple medications for incomplete relief, and welcome any additional option that will help them cope with the pain and anxiety associated with their condition, and improve their quality of life.
Rosner: How does cannabis measure up to the standard treatment options?
Caplan: We don’t quite understand all the details of how it works, but we do know that cannabis is a powerful anti-inflammatory agent, and that it operates in a different way than other anti-inflammatory drugs such as ibuprofen, steroids, or even the biological options available for treating RA and other autoimmune diseases. These traditional drug treatments can cause severe side-effects, many of which we do not see with cannabis.
As a natural option with the ability to quell the type of inflammation specific to RA, cannabis is not new; it has been used as a treatment for various ailments across the globe for thousands of years, including being prescribed by knowledgeable clinicians here in the US prior to its prohibition in the 1930s. But it is a gratifying option for people who have been very limited in their choices.
Rosner: How does cannabis differ in its mode of administration?
Caplan: As with any medicine, treatment results depend on not just the medication product but also the degree that the patient adheres to a regime, and their willingness to explore the different alternatives and variations. In terms of the many types of cannabis dosages and delivery systems available, one of the nice things about cannabis is that the wide range of choices at reputable dispensaries creates a lot of opportunity for flexibility and success for many different types of people with a wide range of ailments. Best of all, this is just the beginning. We are learning more every day, and the industry is growing tremendously, with ever-increasing potential to help more and more people, in ways that are individualized and effective.
Fortunately, all of these options and opportunities for flexibility rest on cannabis’ high safety profile. From this foundation of safety, armed with education, the potential benefits to patients often outweigh the risks.
Rosner: How are your patients embracing this paradigm shift?
Caplan: In my experience, everybody is longing for this. We are stuck in a paternalistic medical system that is dehumanizing people. We have a broken medical system that strips patients of autonomy and power over their own illness, and that in and of itself is unhealthy. We all know it, but it has been a very difficult thing to fix.
Healing with cannabis does not follow a traditional model, where a physician authority decides what the right choice is for a patient. Instead it’s a process undertaken by the patient with the physician’s guidance. Philosophically, if a patient can look back at their own choices as resulting in their own success, they are empowered by that process. I even teach patients how to make their own cannabis-infused lotion that is more effective than anything they will be able to find in a dispensary.
Rosner: On social media, you share and critique the newest research related to cannabis. How do you reconcile between the relatively limited amount of scientific data and your own cannabis practice?
Caplan: Effective clinical medicine requires applying the best available knowledge to unique, personal scenarios. These are all important pieces of a larger puzzle. Yet, in many respects, we have turned off our skepticism of dogmatic science, and I think that’s dangerous. The cannabis movement epitomizes the resistance to traditional medical culture, but I believe there is value to incorporating strong elements of both; clinicians are taught to learn from the science, and how to apply it to new scenarios. We can read about chemical reactions or findings in animal models, and we can incorporate that, with appropriate caution and consideration, into a human medication or therapy treatment plan where the benefits of safe exploration clearly outweigh the potential risks.
Medicine is not a mathematical formula, and individuals aren’t machines. If you don’t know how to read the literature and educate yourself about what is available, you won’t be able to practice the best possible clinical medicine. Every person has unique attributes, and exploring with them an optimal treatment regimen with cannabis brings a critical element of art to the regimented science of medicine.
With the growing use of cannabis as an alternative treatment for medical conditions, some researchers are curious as to its effect on rheumatoid arthritis (RA) and other rheumatoid diseases.
“The pain associated with rheumatic diseases is considered a prevalent indication for medicinal cannabis in various countries. Thus far, preliminary clinical trials have explored the effects of cannabis on RA, osteoarthritis and fibromyalgia,” wrote Daphna Katz-Talmor, et al. in a review published in Nature Reviews Rheumatology.
Those reviewers determined, however, that more research was needed before any clinical recommendations could be made regarding the use of cannabis.
In 2016, another review appeared in the German publication Der Schmerz, which set out to determine if there was evidence to recommend cannabis for pain management in rheumatology patients.
The researchers, Mary-Ann Fitzcharles and coworkers, combed through the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, www.cannabis-med.org, and clinicaltrials.gov for randomized controlled trials. Their criteria included those that were at least two weeks long and had ten patients or more per treatment arm with herbal cannabis or pharmaceutical cannabinoid products in fibromyalgia syndrome, osteoarthritis, chronic spinal pain, and RA pain. “Outcomes were reduction of pain, sleep problems, fatigue and limitations of quality of life for efficacy, dropout rates due to adverse events for tolerability, and serious adverse events for safety,” Fitzcharles and colleagues wrote.
They only found three studies that fit the bill, and the authors noted the risk of bias was high with all three.
“The findings of a superiority of cannabinoids over controls (placebo, amitriptyline) were not consistent. Cannabinoids were generally well tolerated despite some troublesome side effects and safe during the study duration,” Fitzcharles and the other researchers wrote. “Currently, there is insufficient evidence for recommendation for any cannabinoid preparations for symptom management in patients with chronic pain associated with rheumatic diseases.”
Which is why authors of a May 2019 review published in Current Opinion in Rheumatology believe that studying why cannabinoids might be useful to patients will give physicians a clearer direction.
“Due to their anti-inflammatory effects, (endo-) cannabinoids have been considered as a potential therapy for the treatment of rheumatic diseases. However, at the moment there is no significant evidence for the efficacy of cannabinoid-based drugs in the treatment of RA, although it is included in the list of conditions eligible for receiving medical cannabis in Canada and several US states and the majority of patients with arthritis reported beneficial effects of the drug, for example less pain and an opioid-sparing effect,” Torsten Lowin and colleagues wrote.
The authors noted that many RA therapies can interfere with cytokine production or signaling but can have side effects, including infection and immune disturbances.
“Therefore, reduction of proinflammatory cytokine production and signaling without an overt risk of infection would be a preferable treatment of RA,” Lowin and colleagues wrote. “In vitro data and results from animal experiments suggest that cannabinoids might help with just that.”
The researchers noted that the use of cannabis might not only reduce inflammation and pain, but may also help RA patients with comorbidities, such as depression, hypertension, and osteoporosis.
“Significantly, the consumption of cannabis is also associated with lower risk of metabolic syndrome and diabetes and might therefore prevent the RA-induced changes in metabolism,” Lowin and colleagues wrote.
And, it could help patients respond to their treatment, they found.
“Furthermore, CBD might boost the effect of antirheumatic drugs as it has been shown that it increases the uptake of chemotherapeutic compounds into cancer cells,” the authors wrote.
Marni Groves, MSN, NP-C, an assistant in rheumatology at Vanderbilt Department of Medicine in Nashville, Tenn., said that she does feel cannabinoids can be beneficial to patients with RA to reduce joint pain — especially creams and rubs that contain CBD oil. However, she advises patients to use caution when using these products.
“I have had patients who have utilized CBD and hemp creams, rubs, oils, and candies and they do tell me that they feel like their joint and muscle pains are less and more tolerable,” Groves told MedPage Today in an e-mail.
She noted one barrier for patients is the expense, which may not be affordable for everyone. Groves recommends patients also be careful about the product they are purchasing.
“The true content of the oils, creams, rubs, and candies is not verified because these are not FDA regulated,” she added. “Lastly, these products are not advertised (to say) that using these products might cause a positive drug screen.”
While there are many benefits and barriers to the use of cannabis for RA patients, the common theme in the published reviews is that more research is needed. Regardless, this is not likely a topic that will diminish soon.
The Canadian Rheumatology Association even published a position statement in The Journal of Rheumatology this year on the topic.
“Despite lack of evidence for use of medical cannabis in rheumatology patients, we acknowledge the need to provide empathetic and pragmatic guidance for patient care. This position statement aims to facilitate the dialogue between patients and healthcare professionals in a mutually respectful manner to ensure harm reduction for patients and society,” the association concluded.
last updated 08.29.2019
Nature Reviews Rheumatology
Source Reference: Katz-Talmor D, et al “Cannabinoids for the treatment of rheumatic diseases — where do we stand?” Nature Rev Rheumatol 2018; 14: 488–498.
Source Reference: Fitzcharles MA, et al “Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis)” Der Schmerz 2016; 30(1): 47–61.
Current Opinion in Rheumatology
Source Reference: Lowin T, et al “Joints for joints: cannabinoids in the treatment of rheumatoid arthritis” Current Opinion Rheumatol 2019; 3(1): 271-278.
The Journal of Rheumatology
Source Reference: Fitzcharles MA, et al “Position Statement: A Pragmatic Approach for Medical Cannabis and Patients with Rheumatic Diseases” J Rheumatol 2019; 46(5): 532-538.
Can Medical Marijuana Help Rheumatoid Arthritis?
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Many people believe that marijuana, the leaves of the cannabis plant, is useful for treating rheumatoid arthritis (RA), because studies show that it reduces pain and inflammation and aids sleep.
A study in the journal Rheumatology found that RA patients who took cannabis-based medicines had significantly less pain when moving, resting, and sleeping than those who took a placebo. The researchers reported that the differences in the 58 patients they studied over five weeks were small, but significant.
The potential effectiveness of marijuana is found in its active ingredients, delta-9 tetrahydrocannabinol (THC), and cannabidiol (CBM). In a number of studies, both demonstrated anti-inflammatory effects and the potential to slow the progression of RA.
Concerns of Using Cannabis for RA
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Questions to Ask Your Doctor About RA
There are health concerns about using marijuana for RA. RA alone puts you at a greater risk for heart attacks and respiratory ailments, and smoking marijuana may increase those risks.
Smoking marijuana can increase your heart rate anywhere from 20% to 100%, according to the National Institute on Drug Abuse (NIDA). One study found that within the first hour of smoking, your heart attack risk increases nearly five times. If you’re already vulnerable to heart disease, the risk may be even greater.
Smoking any substance can irritate your lungs. Studies show that people who smoke marijuana have the same respiratory problems as do people who smoke tobacco—more coughs, chest colds, and lung infections. One study found that as many as one in 10 people with RA develop lung problems over the course of their lives, and RA makes you susceptible to interstitial lung diseases. These may cause scarring of your lung tissue. That is an important consideration when weighing the pros and cons of smoking any substance, even medical marijuana. In states with medical marijuana dispensaries, you may be able to get the substance in edible products that don’t involve smoking it, such as baked goods and herbal teas. But be careful—there are enormous disparities in the quantity (dose) of active ingredients in edible marijuana products.
Information and Availability Is Limited
Significant studies on the effects of marijuana on RA are lacking. When Australian researchers examined studies on a variety of neuromodulators—substances that can change the way you perceive pain—they found only one that looked at marijuana.
Currently, doctors in several U.S. states are able to prescribe medical marijuana to patients for a variety of ailments, including chronic pain. If you live in one of those states, talk to your doctor about the pros and cons of medical marijuana for RA, and whether it’s an option that’s appropriate for you.
Studies show that medical marijuana reduces inflammation and improves mobility, which are common concerns for people with RA. However, scientific research is very limited.
Smoking marijuana may increase your risk for heart disease and lung disease, which are already higher than average in people with RA.
- Access to medical marijuana for any ailment, including RA, is still limited.
Medical Marijuana For Rheumatoid Arthritis
Updated on January 30, 2019. Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer
The most common cause of disability in America is arthritis. Millions of Americans experience this disorder. As the baby boomer generation enters their golden years, the number of arthritis patients will continue to climb.
There are more than 100 different types of arthritis, and the common feature of each is joint pain and inflammation. Rheumatoid arthritis (RA) presents itself differently than many other types of arthritis. It is an autoimmune disease, as opposed to a joint disorder, and it causes inflammation throughout all the body’s connective tissues.
As the number of sufferers continues to climb, patients are looking for relief. There is no cure, but if the condition is caught early, extended periods of remission are possible.
Medical marijuana has proven to be an effective treatment for rheumatoid arthritis. Not only does it act as an effective pain reliever, but the medicinal properties associated with the herb may also be just what the doctor ordered. Read more to see if cannabis treatments could be the answer you seek.
What Is Rheumatoid Arthritis?
Because arthritis is the most common disorder in the U.S., the costs associated with it are astronomical. One study indicates that arthritis patients incur more than $50 billion in medical bills and work loss every year.
Rheumatoid arthritis does not follow the same rules as other types of arthritis. It’s not just a joint disorder — it’s an autoimmune disease. For reasons no one quite knows, the immune system goes into overdrive and begins attacking healthy body tissue.
Arthritis is commonly associated with the elderly, but RA affects more than just senior citizens. In fact, the average age of onset is from 30 to 60 years of age. There are even cases of children having early-onset RA.
As the immune system attacks the body’s joints, they become swollen and inflamed, leading to chronic pain. The most important joints in the body are commonly affected, including the:
However, RA can affect more than just the joints. As this systemic disorder progresses, it can weaken other parts of the body, organs and systems, such as:
- Bone and cartilage around the joint
- Blood vessels
- Digestive tract
- Nervous system
The progression of RA is typically slow. However, once damage occurs, it’s irreversible. That’s why early diagnosis and the initiation of treatment is so important.
No one test can confirm a rheumatoid arthritis diagnosis. Usually, your physician or a rheumatologist, a doctor specializing in RA, will have to verify it using a combination of the following results:
- Interview and physical examination
- Lab tests and blood tests
- Imaging, such as X-rays or an MRI
Rheumatoid Arthritis Statistics
- More than 1.5 million people have been diagnosed with rheumatoid arthritis in America.
- Doctors estimate 1% of the world’s population has RA.
- The condition affects all races and ethnicities.
- The average age of onset is between 30 and 60 years.
- RA affects three times more women than men.
- Bone and cartilage damage can occur if not caught quickly.
What Causes Rheumatoid Arthritis?
The immune system is the “bodyguard” of the human body. It protects us against assaults such as infections, foreign bodies and wounds. Inflammation is a common byproduct of the immune system in action.
In RA patients, something goes haywire. The immune system produces specialized cells and chemicals that get released into the bloodstream, misdirecting inflammation into the body’s joints.
The synovial membrane (synovium), a protective tissue which lines joints, thickens and becomes inflamed. Inflammation of the synovium is the hallmark of RA, and is called synovitis. If left untreated, the synovitis expands both inside and outside of the joint. This is what causes damage to other parts of the body.
Though doctors understand the workings of rheumatoid arthritis, no one really knows why it occurs. There are some factors that may contribute, including:
- The human leukocyte antigen gene complex has been shown to make people more vulnerable to developing RA.
- The single nucleotide polymorphism (SNP) is a gene variation that causes T-cells to correct joint abnormalities too quickly. The SNP gene often runs in families.
- Environmental factors:
- Secondhand smoke
- Air pollution
- Bacterial or viral issues
- Gender: RA affects 70 percent more women than men.
- Age: The disorder commonly affects those in middle age.
- Family history: Those with a family history of RA are more at risk.
Symptoms and Side Effects of Rheumatoid Arthritis
The symptoms associated with rheumatoid arthritis have the potential to be more severe than other types of arthritis as the condition develops. Because of this, it’s important patients begin treating RA as close to onset as possible. If you believe you suffer from this disorder, listen to your body for clues. Early indicators may be hard to detect. These include:
- Tender joints
- Unintentional weight loss
Throughout the progression of the disorder, symptoms vary from person to person. Patients go from periods of increased symptoms — or flare-ups — to long spans of time where there are no apparent symptoms — or remission.
Interestingly, RA usually affects the body symmetrically. If there are complications on one side of the body, these often are mirrored on the other side.
Common symptoms of RA include:
- Muscle aches
- Slight fever
- Loss of appetite
- Weight loss
If left untreated, RA can lead to loss of function, severe deformities or even disability. Symptoms that could point to more serious complications include:
- Erosion of joints
- Bone loss or erosion
- Shortness of breath
- Dry eyes and mouth
- Eye issues such as impaired vision, burning, itchiness or fluid discharge
- Small lumps under the skin over bony areas, also known as rheumatoid nodules
- Nerve damage causing numbness, tingling or burning
The pain associated with rheumatoid arthritis can leave patients unable to function for extended periods of time. This could affect a person’s job, personal relationships and even psychological health. RA patients commonly suffer from mental illnesses such as:
- Low self-esteem
- Feelings of helplessness
This condition is not fatal. However, it can lead to premature death because of the complications that arise, as well as treatment-related side effects.
Current Treatments Available and Their Side Effects
There is no cure for rheumatoid arthritis, but early diagnosis and treatment are crucial. If left unmanaged, permanent bone or cartilage damage can occur within the first year. Medical treatments and therapy allow patients to continue living happy lives. The goals of any course of RA treatments are:
- Reduce or stop inflammation
- Symptom management
- Pain relief
- Extended periods of remission
- Improved quality of life
- Preventative measures for joint, bone and cartilage damage
- Prevent severe complications associated with RA
Many treatments and therapies exist for rheumatoid arthritis patients. The most popular include the following.
There are many medications used to treat RA. Depending on the progression of the disorder, doctors will prescribe what they feel suits you best. However, many of these drugs can cause serious side effects.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) ease swelling, but are not meant to be a long-term solution. Side effects can include damage to the liver or stomach, ringing in the ears, upset stomach and heart problems.
- Disease-modifying antirheumatic drugs (DMARDs) interrupt attacks caused by the immune system, but can take up to six months to take effect. The main downside is a weakened immune system, which makes patients susceptible to infection. Another possible side effect is liver damage.
- Steroidal medications are fast-acting anti-inflammatories which can only be used as short-term treatments. Side effects include changes in sleep or mood, leg swelling, weight gain, bruising and increased blood pressure.
An active lifestyle is just as important as medication for RA patients. Low-impact exercises like yoga and walking reduce inflammation. It’s also important that RA patients maintain a healthy weight, as being overweight increases risk factors.
Physical therapists work with patients to determine a workout regimen that keeps joints working and flexible. The only downside to this is that RA patients may still find physical activity extremely painful, leading to increased frustration.
Those with pain caused by alignment issues may benefit from these treatments, which focus on manipulating affected joints to bring relief.
However, many health care professionals caution against chiropractics because manipulating joints could worsen the condition and increase pain, especially if joints are inflamed.
Invasive surgery is only used to treat drastic issues and severe joint damage. Any deformities caused by RA are irreversible, but surgery can restore some abilities that may have been lost. It can also repair some parts of the joint. The most common RA operations include:
- Joint replacement
- Joint fusion
- Tendon repair
Surgery always comes with its own sets of risks and potential side effects, which should be discussed with your physician.
Some patients have shown improvement by using holistic remedies and therapies. These include:
- Massages and spa visits
- Supplements like turmeric and Boswellia
- Autoimmune diet
The downsides of these types of treatments are that they either only last a short amount of time before they need to be repeated, or they prove ineffective.
How Is Medical Marijuana an Effective Treatment?
It’s important for RA patients to manage their condition, so many are looking for safer and more affordable alternatives. Using medical marijuana for rheumatoid arthritis is an all-natural treatment that has been shown to improve some of the symptoms associated with the disorder. An added benefit is that it lacks many adverse side effects found in traditional RA medications.
Those using cannabis for rheumatoid arthritis have seen excellent results, including:
- Improved movement
- Reduction of pain
- Less need for other forms of medication
Research studies in this field show scientific evidence that medical marijuana is an effective therapy for arthritis and, more specifically, RA. Cannabis has proven pain-relieving properties. It can be used by itself or in combination with other painkillers, safely and effectively controlling the pain caused by RA.
One of the core symptoms of arthritis is inflammation. There is both research and anecdotal evidence that marijuana acts as an anti-inflammatory. This gives RA patients relief from inflamed joints.
The endocannabinoid system controls the general homeostasis of every person, and acts as a bridge between our body and our mind. Certain conditions, like arthritis, cause our endocannabinoid system to be out of whack. Compounds found in cannabis target cannabinoid receptors present in the synovium of joints, bringing targeted relief from painful symptoms.
Rheumatoid Arthritis Symptoms Treated by Medical Marijuana
As patients find relief from their RA symptoms because of medical marijuana, it becomes a more accepted mode of treatment. The following symptoms are showing great improvements because of cannabis.
The cannabinoid compounds tetrahydrocannabinol (THC) and cannabidiol (CBD) found in marijuana have proven medical properties. Among these is pain relief. Certain strains of marijuana can target pain and bring much-needed relief.
Best strains: Canna Tsu, Death Bubba, Girl Scout Cookies
Multiple cannabinoids in marijuana work to reduce inflammation. These include CBD and THC, as well as CBC, CBDa, CBG, CBN and THCa.
Best strains: Blue Dream, Granddaddy Purple, Gorilla Glue #4
Because of chronic pain and the general malaise caused by RA, fatigue is a common symptom in many patients. The Indica strain of marijuana is known for its sleep-inducing properties. And a well-rested patient is far more likely to have a better chance of remission.
Best Strains: Skywalk, God’s Gift, Afghan Kush
If patients are in the midst of an RA flare-up, they may also suffer from feelings of anxiety and depression. The chronic nature of the disorder can cause patients to feel hopeless. Medical marijuana is shown to relieve both anxiety and depression and give patients an improved outlook on life.
Best Strains: Holy Grail Kush, Tahoe OG Kush, Jack Herer
Methods of Treatment Available
Because rheumatoid arthritis can lead to lung issues, smoking cannabis products is not recommended. However, there are many safer ingestion alternatives, including:
- Tinctures & drops: Taken under the tongue, this mode of ingestion releases cannabis medication directly into the bloodstream.
- Edibles: It sometimes takes longer for patients to feel the medication when they ingest marijuana edibles, but the effects tend to last longer. This allows for longer times of relief.
- Vaporization: Vaping is one of the most popular modes of cannabis use because it has the fast-acting benefits of smoking, without the risks.
- Topicals and transdermal patches: Cannabis creams and patches can be applied directly to the painful joints. The medication seeps into the skin right above the affected area.
How to Get Medical Marijuana Treatments
If you have rheumatoid arthritis and you need medical advice about cannabis treatments, let us connect you with hundreds of qualified marijuana doctors near you.
Information About Medical Marijuana and Rheumatoid Arthritis
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