Medical Marijuana and Rheumatoid Arthritis

Millions of Americans suffer from arthritis, the most common cause of disability in America. And as the baby boomer generation ages, the prevalence of arthritis will continue to climb.

Arthritis is a joint disorder featuring inflammation, and is frequently accompanied by joint pain. There are more than 100 different types of arthritis. The types range from those related to wear and tear of cartilage, such as osteoarthritis, to those associated with inflammation resulting from an overactive immune system, such as rheumatoid arthritis. Together, the many types of arthritis make up the most common chronic illness in the United States, which costs patients billions of dollars. For example, according to a Stanford University study titled "The economic impact of arthritis," patients with arthritis collectively incur over $56 billion in medical expenditures and work loss each year.

Currently, more than 100 medications and drugs are used in the treatment of arthritis. Many of these drugs, however, can cause serious side effects. Many patients who suffer from arthritis have opted instead to use medical marijuana, which is an affordable, natural alternative that lacks the side effects found in the medicines traditionally used to treat arthritis. These patients have seen excellent results with medical marijuana, with improved movement, less pain, and less use of other medications.

Recent research has shown that medicinal marijuana can be an effective alternative arthritis treatment. Marijuana is a strong analgesic (pain reliever) and, when used by itself or in combination with other pain-killers, has been found to safely and effectively control the pain from arthritis. Studies have also shown that marijuana suppresses inflammation—which is the core symptom of arthritis.

Findings: Effects of Cannabis on Rheumatoid Arthritis

Clinical research analyzing cannabis effect specifically on Rheumatoid Arthritisis limited. However, studies have demonstrated cannabis’ potent anti-inflammatory and pain-relieving effects, and preclinical studies support the idea that the endocannabinoid system is involved in alleviating Rheumatoid Arthritisis pain (La Porta, et al., 2014). In an animal trial, a cannabinoid found in cannabis, cannabidiol (CBD), was shown to effectively block the progression of arthritis. Researchers found that CBD protected joints against severe damage and concluded that CBD offers a potent anti-arthritic effect (Malfait, et al., 2000). Other studies have found that synthetic cannabinoids offer strong anti-inflammatory and immunosuppressive properties and reduce joint damage in mice with osteoarthritis (Sumariwalla, et al., 2004) (Sumariwalla, et al., 2009).

Pain caused by Rheumatoid Arthritisis can be nociceptive or neuropathic. Cannabis cannabinoids like CBD and tetrahydrocannabinol (THC) activate the CB1 and CB2 receptors of the endocannabinoid system, which have been found to regulate the release of neurotransmitter and central nervous system immune cells to manage both nociceptive and neuropathic pain levels (Woodhams, Sagar, Burston & Chapman, 2015). Activating of the CB1 receptor has been specifically found to reduce pain sensitivity in the osteoarthritic knee joints of rats (Schuelert & McDougall, 2008). Another animal study found that activating CB2 receptors reduces pain and inflammation associated with osteoarthritis (Burston, et al., 2013).

Maintaining healthy bone helps reduce the risk of Rheumatoid Arthritisis and studies have shown that cannabis and its cannabinoids help modulate bone growth and maintenance. By activating the CB1 and CB2 receptors, cannabinoids help manage proper bone formation by restraining bone resorption and enhancing bone formation (Bab & Zimmer, 2008) (Idris, et al., 2009) (Ofek, et al., 2006).

References:

Bab, I., & Zimmer, A. (2008). Cannabinoid receptors and the regulation of bone mass. British Journal of Pharmacology, 153(2), 182–188. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219540/.

Baron, E.P. (2015, June). Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It’s Been… Headache, 55(6), 885-916. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1111/head.12570/full.

Burston, J.J., Sagar, D.R., Shao, P., Bai, M., King, E., Brailsford, L., Turner, J.M., Hathway, G.J., Bennett, A.J., Walsh, D.A., Kendall, D.A., Lichtman, A., and Chapman, V. (2013). Cannabinoid CB2 Receptors Regulate Central Sensitization and Pain Responses Associated with Osteoarthritis of the Knee Joint. PLoS ONE, 8(11), e80440. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840025/.

Idris, A.I., Sophocleous, A., Landao-Bassonga, E., Canals, M., Milligan, G., Baker, D., van’t Hof, R.J., and Ralston, S.H. (2009, August). Cannabinoid receptor type 1 protects against age-related osteoporosis by regulating osteoblast and adipocyte differentiation in marrow stromal cells. Cell Metabolism, 10(2), 139-47. Retrieved from http://www.cell.com/cell-metabolism/fulltext/S1550-4131(09)00202-2.

La Porta, C., Bura, S.A., Negrete, R., and Maldonado, R. (2014, February). Involvement of the endocannabinoid system in osteoarthritis pain. The European Journal of Neuroscience, 39(3), 485-500. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1111/ejn.12468/full.

Malfait, A.M., Gallily, R., Sumariwalla, P.F., Malik, A.S., Andreakos, E., Mechoulam, R., and Feldmann, M. (2000). The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proceedings of the National Academy of Sciences of the United States of America, 97(17), 9561–9566. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC16904/.

Ofek, O., Karsak, M., Leclerc, N., Fogel, M., Frenkel, B., Wright, K., Tam, J., Attar-Namdar, M., Kram, V., Shohami, E., Mechoulam, R., Zimmer, A., and Bab, I. (2006). Peripheral cannabinoid receptor, CB2, regulates bone mass. Proceedings of the National Academy of Sciences of the United States of America, 103(3), 696–701. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334629/.

Osteoarthritis. (n.d.). Arthritis Foundation. Retrieved from http://www.arthritis.org/about-arthritis/types/osteoarthritis/.

Osteoarthritis. (2014, October 9). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/osteoarthritis/basics/definition/con-20014749.

Richardson, D., Pearson, R.G., Kurian, N., Latif, M.L., Garle, M.J., Barrett, D.A., Kendall, D.A., Scammell, B.E., Reeve, A.J., and Chapman, V. (2008). Characterisation of the cannabinoid receptor system in synovial tissue and fluid in patients with osteoarthritis and rheumatoid arthritis. Arthritis Research & Therapy, 10:R43. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453762/.

Schuelert, N., and McDougall, J.J. (2008, January). Cannabinoid-mediated antinociception is enhanced in rat osteoarthritic knees. Arthritis and Rheumatism, 58(1), 145-53. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/art.23156/full.

Sumariwalla, P.F., Gallily, R., Tchilibon, S., Fride, E., Mechoulam, R., and Feldmann, M. (2004, March). A novel synthetic, nonpsychoactive cannabinoid acid (HU-320) with antiinflammatory properties in murine collagen-induced arthritis. Arthritis and Rheumatism, 50(3), 985-98. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/art.20050/full.

Sumariwalla, P.F., Palmer, C.D., Pickford, L.B., Feldmann, M., Foxwell, B.M., and Brennan, F.M. (2009, January). Suppression of tumour necrosis factor production from mononuclear cells by a novel synthetic compound, CLX-090717. Rheumatology (Oxford), 48(1), 32-8. Retrieved from https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/ken398.

Woodhams, S.G., Sagar, D.R., Burston, J.J., and Chapman, V. (2015). The role of the endocannabinoid system in pain. Handbook of Experimental Pharmacology, 227, 119-43. Retrieved from http://link.springer.com/chapter/10.1007%2F978-3-662-46450-2_7.

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