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CBD For Rheumatoid Arthritis

Kimberly is a health and wellness writer with 8 years of experience in healthcare and a special passion for mental health awareness.

Scott J. Zashin, MD, specializes in the treatment of rheumatologic and musculoskeletal conditions using both traditional and alternative therapies.

As cannabidiol (CBD) has grown in popularity over the years, major organizations like the Arthritis Foundation have released guidelines pertaining to its use in the treatment of rheumatoid arthritis (RA). CBD is a non-psychoactive component of cannabis. The CBD in most products is extracted from hemp, a variety of cannabis that only has traces (up to 0.3%) of THC, the active compound that gets people high. Studies have shown CBD can help reduce chronic pain by impacting endocannabinoid receptor activity, which may also reduce inflammation.

CBD comes in different forms, including oil, vape, edible, and topical. Oils, vapes, and edibles are taken orally, while topical CBD lotions can be applied to the skin. CBD dosage varies depending on the form, the indication, and other treatments being used.

What Is Rheumatoid Arthritis?

RA is an autoimmune inflammatory disease, in which the immune system attacks healthy cells in the body and causes inflammation. RA commonly affects joints in the hands, wrists, and knees, causing the joint lining to become inflamed and damaging the tissue. This causes chronic joint pain and leads to deformity. RA can also affect other tissues throughout the body, such as the lungs, heart, and eyes.

medicinal cream with CBD oil, bottle of cannabis oil, capsule

Vera Livchak / Getty Images

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Vera Livchak / Getty Images

Health Benefits of CBD for RA

Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated with quality studies in humans. Anecdotally, some people who have tried CBD for treatment of arthritis symptoms report noticeable pain relief, improved sleep improvement, and reduced anxiety.

The trials that have been conducted in humans have not yielded strong evidence for the use of CBD in managing arthritic pain.

  • A randomized trial of topical CBD for treatment of knee osteoarthritis lasted only 12 weeks, and results were mixed.
  • One of the largest reviews examining the health effects of cannabis and CBD concluded that there is substantial evidence that cannabis is an effective treatment for chronic pain in adults. There was, however, no specific conclusion regarding CBD, as definitive studies were not available.
  • More recently, a new study showed that CBD can potentially help alleviate RA pain and inflammation by acting on immune cells that are attacking healthy cells in the body. It’s important to note that this study was also not conducted with human subjects.

Research in this area is ongoing.

If you are interested in trying CBD for RA pain management, be sure to talk to your doctor first before using any CBD products.

Rising Popularity of CBD for RA

Based on a 2019 national survey of 2,600 people conducted by the Arthritis Foundation, 79% of respondents said they were using CBD, have used it in the past, or were considering using it to help with their arthritis pain.

Health Benefits Related to Arthritis

Given the lack of strong scientific evidence supporting the use of CBD, it is not recommended as the first choice for pain relief in RA.

If you have RA, you should not stop taking your prescribed medications that may be protecting your joints from future damage. You should discuss any changes you want to make to your medication regimen with your doctor.

Additional Health Benefits

The strongest scientific evidence for effectiveness of CBD as a medical treatment is for seizure prevention in Dravet syndrome and Lennox-Gastaut syndrome, which are severe childhood epilepsy disorders that typically don’t respond to antiseizure medications. Several years ago, the FDA approved the first cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.

Other potential health benefits of CBD include:

  • Reduce anxiety, insomnia, and depression
  • Relieve cancer or cancer treatment symptoms
  • Clear acne
  • Slow the progress of neurologic disease like Alzheimer’s disease

Possible Side Effects

Treatment with CBD should be started slowly and under the supervision of a doctor, who will oversee its effectiveness and side effects. There have been reports of mild side effects of CBD.

The most common side effects include:

  • Nausea
  • Fatigue
  • Irritability
  • Diarrhea
  • Dry mouth
  • Lightheadedness
  • Sleepiness
  • Low blood pressure
  • Appetite changes

It’s important to note that CBD may interact with other drugs, including some of the medications that are prescribed for the treatment of RA.

Warnings and Interactions

There are some warnings and adverse drug interactions to be aware of before beginning using CBD for management of RA-associated pain.

Warnings

Do not stop taking any other treatments without consulting your doctor. Additionally, CBD shouldn’t be a replacement for other therapies you are using.

Pregnant people and children should consult a doctor before using CBD since there isn’t enough research on the effects of CBD on these populations. There has been concern about a possible link between inhaled cannabis and lower-birthweight babies, but it’s not clear if this applies to CBD.

Currently, the U.S. Food and Drug Administration (FDA) does not regulate the safety and purity of CBD products, so you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. The product may contain other unknown elements. The most effective therapeutic dose of CBD for any particular medical condition has not been established.

Are CBD Products Legal?

CBD products derived from hemp are no longer considered schedule I drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone.   There are changes underway on federal and state levels that will ultimately clarify the laws and regulations related to CBD-based products and sales. Despite that, they’re widely available in nearly every state and online. People who want to use CBD should check their own state laws.

Interactions

Studies have found moderate interactions between CBD and medications commonly prescribed for treating RA.

Interactions can occur with these medications:

  • Corticosteroids
  • Tofacitinib
  • Naproxen
  • Celecoxib
  • Tramadol
  • Some antidepressants, including amitriptyline, citalopram, fluoxetine, mirtazapine, paroxetine, and sertraline
  • Some medications used for treating fibromyalgia, including gabapentin and pregabalin

CBD can increase your level of coumadin, a blood thinner.

CBD may also raise levels of other medications in your blood by the same mechanism that grapefruit juice does.

Medications that interact with grapefruit juice can potentially interact with CBD, including:

  • Cholesterol medications
  • High blood pressure medications
  • Organ-rejection medications
  • Anti-anxiety medications
  • Corticosteroids
  • Heart medications
  • Some antihistamines

Preparation and Dosage

If you’ve decided to try CBD for treating your RA pain, the next step is figuring out how much to take.

Your dosage depends on a number of factors:

  • Body weight
  • Medical indication
  • The concentration and form of CBD that you’re taking

You will likely need to start with a low dose and find what works for you. Studies have found extreme differences in dosages, with some people using 5 milligrams (mg) and others as much as 600 mg.

Your healthcare provider may direct you to start with 20-40 mg per day and increase slowly each day until you feel the relief you’re looking for.

To ensure that you are using CBD safely and effectively for pain management, you should:

  • Choose an oral treatment (rather than inhaled products) and start with a low dose
  • Establish initial goals of treatment within a realistic period of time. For example, a reduction in knee pain that allows you to walk around the block within two weeks of starting treatment; later, if improved, the goals can be adjusted
  • Tell your doctor(s) about your planned and current CBD treatment; monitor your pain and adjust medications with your medical providers, rather than with non-medical practitioners
  • When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose

If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, you could consider talking to your doctor about taking CBD with a very low-dose THC product. Be aware that even at low levels, THC may make you feel high, resulting in cognitive, motor, and balance impairment.

If you experience any unwanted side effects when using a CBD product, immediately discontinue use and inform your doctor.

What To Look For

Look for the following when choosing a CBD product:  

  • Look for products manufactured in the United States with ingredients grown domestically
  • Choose products made by companies that follow good manufacturing practices established by the FDA for pharmaceuticals or dietary supplements or required by the state where they are manufactured
  • Buy from companies that test each batch and provide a certificate of analysis from an independent lab that uses validated standardized testing methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP), or the Association of Official Agricultural Chemists (AOAC)
  • Avoid companies that claim their products have disease benefits
  • Be aware that marketers and people behind retail counters are not health professionals. Your doctor is your best source for guidance and monitoring when using an unregulated product

A Word From Verywell

CBD may sound like an appealing option for pain relief, but do your due diligence before jumping on the bandwagon. A lot of people say CBD can help reduce pain and inflammation for those with RA, but not a lot of strong scientific data have substantiated that claim. That said, serious effects are not commonly associated with CBD use.

If this is something you are interested in, you can work with your doctor to figure out whether CBD is something you can try safely. Remember that CBD should not be used as a first-line treatment for RA pain and that it’s not advisable to stop taking disease-modifying treatments for RA.

Cannabidiol, a non-psychoactive component of marijuana, may help to relieve pain and joint stiffness in people with RA. Here’s what you need to know.

Cannabis for pain? Hype or hope?

Cannabis and cannabis-based derivatives such as CBD cannabidiol are often used or enquired about for pain management in RA, but is there evidence that they are effective as painkillers?

Taken from NRAS magazine, 2018

While at the European League Against Rheumatism congress in Madrid in June Iain, our Head of RA Services and I attended a lecture on the topic of cannabis and cannabis-based derivatives such as CBD cannabidiol.

The use of cannabis-based products to treat pain in RA is a topic that comes up regularly in discussions on Facebook and our online community on HealthUnlocked, so I thought it would be useful to share a summary of the lecture here.

The question is, can medical cannabis be recommended as a new analgesic option in musculoskeletal conditions? The answer is not simple or clear-cut according to Professor Serge Perrot, Professor of Clinical Pharmacology at Paris Descartes University and a rheumatologist and Head of the Pain Centre at Cochin-Hotel Dieu Hospital, Paris. “All the meta-analyses (examination of data from a number of independent studies of the same subject, in order to determine overall trends) and literature reviews have demonstrated that, for example in fibromyalgia, in back pain, in neuropathic pain, “it was not very different from placebo.” That said there are “specific clinical cases” where cannabis-based treatments may be useful on an individual basis, which “speaks in favour of authorising the products”, said Prof. Perrot. He went on to say that emerging data suggests that cannabis-derived medicines may prove to be more effective for conditions such as anxiety, sleep disorders, and loss of appetite, rather than specifically for pain.

Dr Steve Alexander, Associate Professor in molecular pharmacology at the University of Nottingham Medical School, said that some of the effects – or side effects – of these medicines might be relevant to rheumatology patients. For example, the drowsiness that has been associated with some cannabis preparations could be beneficial, since improved sleep does affect people’s subjective scores of pain.

Dr Alexander in an interview with the Congress News said “We know there’s a broader story, and that it’s not just pain itself – it’s all the ancillary things that go alongside it, such as anxiety, depression, comorbidities, and so on. I think, therefore, that the message is one of tentative hope.”

According to Dr Alexander, there was in the order of 85 registered clinical trials for cannabinoids in a variety of conditions being conducted, and if only a modest proportion of these trials prove to be successful, he suggests “that’s quite a major advance”.

While the lectures from both Prof. Perrot and Dr Alexander were quite complex and scientific, my big take-home message was that there is still a huge amount of research required and it is not as simple as some messaging on social media would have you think. I feel that far more clarification is required when talking about cannabis as there are many different varieties of cannabis plants and products out there. There is a massive difference between medicinal cannabis and what some chap in the pub may offer you in a little plastic bag! In a recent Time magazine article, I also read that only 31% of CBD products that were tested actually had the amount of CBD in them that they claimed on their labels!

In conclusion, NRAS will keep a watchful eye on developments in this controversial topic but as it stands today our position is that there is still no proven scientific evidence of benefit for those living with inflammatory arthritis. I would highly recommend that extreme caution should be taken when purchasing any CBD products or indeed any other ‘complementary’ products, online or via high street retailers without due-diligence and research into the producers of the product and always tell your rheumatology team what you are taking alongside your usual RA medication/s.

Footnote: In the US, the FDA (Food and Drug Administration) has taken action against some CBD manufacturers making specific condition-related health claims; however, many companies are still unabashedly marketing products as curatives. In short, this is big business, and it will take some time to bring in proper regulation to ensure safety.

By Clare Jacklin, CEO

Medicines in rheumatoid arthritis

We believe it is essential that people living with RA understand why certain medicines are used, when they are used and how they work to manage the condition.

Cannabis and cannabis-based products are often used or enquired about for pain management in RA, but are they effective?