Medical Cannabis and Arthritis
The term “arthritis” literally means inflammation of a joint (an area where bone meets bone) and is commonly used to describe a number of different medical conditions that involve pain and stiffness in or around one or more joints. There are over 100 different types of arthritis altogether.
Common Types of Arthritis
- Osteoarthritis (the most common type of arthritis)
- Rheumatoid arthritis
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis (Reiter syndrome)
- Systemic lupus erythematosis (SLE)
- Traumatic arthritis
An estimated 46 million adults have some form of arthritis. This number is expected to increase to 67 million Americans by 2030. Arthritis affects both men and women.
Symptoms of Arthritis
- Joint pain
- Joint swelling
- Joint stiffness, especially in the morning
- Reduces ability to move a joint
- Red skin around a joint
- Warmth around a joint
The arthritic process involves the breakdown of cartilage. Cartilage serves to protect joints, allowing them to move smoothly. Cartilage also serves as a shock-absorber between bones. Without the normal amount of cartilage, bones rub together resulting in pain, stiffness, and inflammation.
Causes of Joint Inflammation
- Autoimmune disease (the body’s immune system mistakenly attacks healthy tissue)
- Broken bones
- Joint “wear and tear”
- Infection (bacterial, viral)
Persons with arthritis have been shown to have significantly worse health-related quality of life than persons without arthritis.
Unfortunately, there currently is no cure for arthritis. The treatment of arthritis is largely aimed at relieving symptoms, improving function, and trying to halt the progression of the disease.
Conventional treatments include a variety of different medications, physical or occupational therapy, splints or joint assistive devices, and in some cases even joint replacement surgery.
A variety of pharmaceutical medications are used to treat arthritis, including pain relievers such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve). There are many side effects associated with NSAIDs, however. Long term use of NSAIDs has been associated with heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage. The use of NSAIDs has been reported to cause somewhere between 7,000 and 16,000 deaths annually.
Other types of prescription medications used to treat arthritis include:
- Biologics: Etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), abatacept (Orencia), rituximab (Rituxan), golimumab (Simponi), certolizumab (Cimzia), and tocilizumab (Actemra)
- Corticosteroids: Cortisone, prednisone, methylprednisolone
- Disease-modifying anti-rheumatic drugs (DMARDs) for autoimmune arthritis: Methotrexate, gold salts, penicillamine, sulfasalazine, and hydroxycholoquine
- Immunosuppressants for rheumatoid arthritis when other medications have not worked: azathioprine and cyclophosphamide
While these drugs may improve the quality of life for many patients, they are also associated with very serious, even potentially fatal, side effects.
Complementary and Alternative Medicine
There are a number of complementary and alternative treatments that may be effective in treating arthritis. Similar to conventional methods, goals of treatment include reducing pain, improving function, and preventing further joint damage. It is important to remember that most forms of arthritis cannot be cured, and arthritis represents a long-term (chronic) condition.
Lifestyle changes are the preferred way to treat arthritis. Exercise programs and some form of physical therapy can help to relieve stiffness, pain, and fatigue and improve muscle and bone strength.
Types of exercise programs
- Low-impact aerobics
- Range of motion exercises
- Strength training
Types of physical therapy
- Heat and/or ice
- Water therapy
- Electrical stimulation
- Mind-body medicine
- Progressive relaxation
The Arthritis Foundation provides a very good resource for dietary supplements and other substances that might be useful for specific types of arthritis and related conditions.
- Ankylosing spondylitis: DHEA, melatonin
- Fibromyalgia: SAM-e, St. John’s wort, valerian
- Gout: Devil’s claw, stinging nettle
- Lupus: DHEA, Fish oil, flax, thunder god vine
- Osteoarthritis: ASU, bromelain, cat’s claw, chondroitin, devil’s claw, DMSO, ginger, glucosamine, Indian frankincense, MSM, SAM-e, stinging nettle, tumeric
- Psoriasis: Fish oil
- Raynauds’ Phenomenon: Evening primrose, flax, ginger, ginkgo, gamma-linolenic acid (GLA)
- Rheumatoid Arthritis: Black currant oil (or seed), borage oil (or seed), bromelain, DMSO, evening primrose, fish oil, flax, ginger, GLA, Indian frankincense/bosswellia, thunder god vine, tumeric
- Scleroderma: DMSO
- Sjorgren’s Syndrome: GLA
Many patients also report that medical cannabis is quite effective in relieving their symptoms of arthritis. Patients commonly say that medical cannabis provides relief of their symptoms of pain and inflammation better than pharmaceutical medications with significantly fewer side effects. Medical cannabis may also be effective in treating associated symptoms of anxiety, depression, and insomnia.
Historically, the relief of joint swelling and inflammation is one of the oldest known uses of cannabis, dating back to China around 5,000 years ago.
Scientifically, there is basis for the use of cannabis in the treatment of arthritis. Two of cannabis’ key medicinal ingredients, tetrahydrocannabinol (THC) and cannabidiol (CBD), haves been well documented to have pain relieving and anti-inflammatory properties. Altogether, there are over 100 unique cannabinoid molecules in the marijuana plant.
Highlights from the Scientific Literature
Formukong EA, et al. (1988). Analgesic and anti-inflammatory activity of constituents of cannabis sativa L.
- Results: The cannabinoids delta 1-tetrahydrocannabinol (delta 1-THC), cannabinoid (CBD), and cannabinol (CBN) were demonstrated to have pain and inflammation-relieving effects in mice.
- Conclusion: Results suggest a structural relationship between analgesic activity and anti-inflammatory activity among the cannabinoids related to their peripheral actions and separate from the central effects of delta 1-THC.
Malfait AM, et al. (2000). The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis.
- Conclusions: CBD (cannabidiol), the major nonpsychoactive component of cannabis, has potent anti-arthritic effect in murine (mouse) collagen-induced arthritis through its combined immunosuppressive and anti-inflammatory actions.
Idris A. (2008). Role of cannabinoid receptors in bone disorders: alternatives for treatment.
- Review article examining the role of cannabinoid receptors in regulating bone mass, bone loss, and bone cell function in health and disease.
- The article provides support to the notion that cannabinoid receptor ligands show great promise in the treatment of bone diseases associated with accelerated osteoclastic bone resorption, including osteoporosis, rheumatoid arthritis, and bone metastasis.
Medical Marijuana Patient Information
Besides smoking, delivery methods for the use of medical cannabis include vaporization, tinctures, teas, and edible products. Most commonly reported side effects from the use of medical cannabis include dry mouth, red eyes, increased appetite, and tiredness. There has never been a death attributable to a medical cannabis overdose. Medical cannabis should be used in consultation with a physician who specializes in cannabinoid medicine.
Natural Treatment Recommendations for Arthritis Patients
Following are suggestions from the U.S. National Library of Medicine’s PubMed Health:
- Get plenty of sleep
- Avoid staying in one position for too long
- Avoid positions or movements that put stress on sore joints
- Avoid excessive, repetitive motions
- Adapt your environment to make life easier (e.g., grab bars in the bathroom)
- Try stress-relieving activities (e.g., meditation, yoga, tai chi)
- Eat a healthy diet rich in omega-3 fatty acids (e.g., cold water fish such as salmon, mackerel, and herring, flax seed, canola oil, soybeans, soybean oil, pumpkin seeds, walnuts)
- Apply capsaicin cream over painful joints
- Lose weight
Contact Dr. Rabe
References and Resources
Arthritis Foundation. Arthritis Today. Supplements for Your Condition. http://www.arthritistoday.org/treatments/supplement-guide/conditions.php
Centers for Disease Control and Prevention. Arthritis. http://www.cdc.gov/arthritis/basics/general.htm
Formukong EA, Evans AT, Evans FJ. Analgesic and anti-inflammatory activity of constituents of cannabis sativa L. Inflammation. 1988;12(4):361-371. http://www.ncbi.nlm.nih.gov/pubmed?term=3169967
Idris A. Role of cannabinoid receptors in bone disorders: alternative for treatment. Drug News and Perspectives. 2008;21(10):533-540. http://www.ncbi.nlm.nih.gov/pubmed/19221634
Malfait AM, Gallily R, Sumariwalla PF. The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proceedings of the National Academy of Sciences. 2000;97(17):9561-9566. http://www.ncbi.nlm.nih.gov/pubmed/10920191
Tamblyn R, Berskson L, Dauphine WD, et al. Unnecessary Prescribing of NSAIDs and the Management of NSAID-Related Gastropathy in Medical Practice. Annals of Internal Medicine. 1997;127(6):429-438. http://www.annals.org/content/127/6/429.abstract
Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal Toxicity of Nonsteriodal Antiinflammatory Drugs. New England Journal of Medicine. 1999;340:1888-1899. http://www.nejm.org/doi/full/10.1056/NEJM199906173402407
U.S. National Library of Medicine. PubMed Health. Arthritis. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223/