Arthritis: Cannabinoids and CBD Research Overview

Arthritis is a disorder that causes inflammation and pain of one or more joints. Studies have shown cannabinoids have anti-arthritic effects and can help manage pain and inflammation associated with the disorder.

Overview of Arthritis

Arthritis is a condition characterized by joint pain. There are 100 different types of arthritis, according to the Arthritis Foundation, but common symptoms among all the types include swelling, pain, stiffness and decreased range of motion.

The most common type of arthritis is osteoarthritis, or degenerative joint disease, which is the wearing down of the protective cartilage on the ends of bones. Another common type is rheumatoid arthritis, which is when the body’s immune system mistakenly attacks healthy cells, including the synovium that lines the joints. Other more common types of arthritis include juvenile arthritis, which develops in children; psoriatic arthritis, which affects people with psoriasis; infectious arthritis, which is an infection that spreads to a joint; and gout, which is caused by the buildup of uric acid.

The pain, swelling and stiffness associated with arthritis can fluctuate in severity and varies between individual. Severe arthritis can cause such intense chronic pain that the ability to maintain daily activities is affected.

Arthritis treatment focuses on relieving pain and swelling with medications, physical therapy, and in some cases, surgery.

Findings: Effects of Cannabinoids and CBD on Arthritis

Preclinical trials suggest that cannabis can help limit the damage of different types of arthritis. In an animal trial, cannabidiol (CBD), a major cannabinoid found in cannabis, effectively blocked the progression of arthritis. Researchers found that CBD protected joints against severe damage and concluded that CBD offers a potent anti-arthritic effect⁶.

Other studies have found that cannabinoids offer strong anti-inflammatory and immunosuppressive properties and reduce joint damage in mice with osteoarthritis^8,9. Most recently, cannabinoid treatments were found effective for reducing osteoarthritis-related cartilage breakdown⁴.

Research has also shown that cannabis can help manage the pain and inflammation associated with arthritis. CBD, and another major cannabinoid found in cannabis — tetrahydrocannabinol (THC) — activate the two main cannabinoid receptors (CB₁ and CB₂) of the endocannabinoid system within the body. These receptors regulate neurotransmitter release and central nervous system immune cells to reduce pain¹¹. Activating the CB₁ receptor has been specifically found to reduce pain sensitivity in the osteoarthritic knee joints of rats⁷. One study found that cannabis-based medicine significantly improved pain during joint movement, pain while at rest, and quality of sleep in patients with rheumatoid arthritis³. Numerous preclinical studies have confirmed cannabis’ anti-inflammatory and pain-relieving effects and they support the idea that the endocannabinoid system is involved in alleviating pain associated with arthritis⁵.

States That Have Approved Medical Cannabis for Arthritis

Currently, Arkansas, California, Illinois (osteoarthritis, rheumatoid arthritis), and New Mexico have approved medical cannabis for the treatment of arthritis.

However, in Washington D.C., any condition can be approved for medical cannabis as long as a DC-licensed physician recommends the treatment. In addition, various other states will consider allowing medical cannabis to be used for the treatment of arthritis with the recommendation from a physician. These states include: Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).

Several states have approved medical cannabis specifically to treat “chronic pain,” which is a symptom commonly associated with multiple sclerosis. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, and West Virginia. The states of Montana, Nevada, New Hampshire, North Dakota, Ohio and Vermont allow medical cannabis to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania, Washington, and West Virginia have approved cannabis for the treatment of “intractable pain.”

Recent Studies on Cannabinoids and CBD’s Effect on Arthritis

Activating CB2 receptors reduces osteoarthritic knee pain.
Cannabinoid CB2 Receptors Regulate Central Sensitization and Pain Responses Associated with Osteoarthritis of the Knee Joint.
(http://www.ncbi.nlm.nih.gov/pubmed/24282543)

CBD found to have anti-inflammatory and immunosuppressive effects, and therefore shown to be a potent anti-arthritic.
The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis.
(http://www.pnas.org/content/97/17/9561.full)

Resources:

1. Arthritis. (2014, July 15). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/arthritis/basics/definition/con-20034095.
2. Arthritis. (n.d.). MedlinePlus. Retrieved from https://www.nlm.nih.gov/medlineplus/arthritis.html – cat51.
3. Blake, D.R., Robson, P., Ho, M., Jubb, R.W., and McCabe, C.S. (2006, January). Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology, 45(1), 50-2.
4. Kong, Y., Wang, W., Zhang, C., Wu, Y., Liu, Y., and Zhou, X. (2016, June). Cannabinoid WIN‑55,212‑2 mesylate inhibits ADAMTS‑4 activity in human osteoarthritic articular chondrocytes by inhibiting expression of syndecan‑1. Molecular Medicine Reports, 13(6), 4569-76.
5. 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.
6. 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.
7. Schuelert, N., and McDougall, J.J. (2008, January). Cannabinoid-mediated antinociception is enhanced in rat osteoarthritic knees. Arthritis and Rheumatism, 58(1), 145-53.
8. 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.
9. 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.
10. What Is Arthritis? (n.d.). Arthritis Foundation. Retrieved from http://www.arthritis.org/about-arthritis/understanding-arthritis/what-is-arthritis.php.
11. 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.