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Arthritis is a disorder that causes inflammation and pain of one or more joints. Studies have shown cannabis has 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 Cannabis 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 effect9.
Other studies have found that synthetic cannabinoids offer strong anti-inflammatory and immunosuppressive properties and reduce joint damage in mice with osteoarthritis4,9,10. Most recently, cannabinoid treatments were found effective for reducing osteoarthritis-related cartilage breakdown7.
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. Studies have shown the cannabinoid receptor system present in the synovium of joints could be a therapeutic target for addressing the pain and inflammation associated with osteoarthritis and rheumatoid arthritis6,10. These two receptors regulate neurotransmitter release and central nervous system immune cells to reduce pain14. Activating the CB1 receptor has been specifically found to reduce pain sensitivity in the osteoarthritic knee joints of rats10. 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 arthritis8.
States That Have Approved Medical Marijuana for Arthritis
Currently, Arkansas, California, Illinois (osteoarthritis, rheumatoid arthritis), and New Mexico have approved medical marijuana for the treatment of arthritis. However, in Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment. In addition, various other states will consider allowing medical marijuana 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 marijuana specifically to treat “chronic pain,” a symptom commonly associated with arthritis. 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 Nevada, New Hampshire, North Dakota, Montana, Ohio and Vermont allow medical marijuana 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 Cannabis’ Effect on Arthritis
- Arthritis. (2014, July 15). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/arthritis/basics/definition/con-20034095.
- Arthritis. (n.d.). MedlinePlus. Retrieved from https://www.nlm.nih.gov/medlineplus/arthritis.html – cat51.
- 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. Retrieved from https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/kei183.
- 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/.
- Dunn, S.L., Wilkinson, J.M., Crawford, A., Le Maitre, C.L., Bunning, R.A. (2014, January). Cannabinoid WIN-55,212-2 mesylate inhibits interleukin-1b induced matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase expression in human chondrocytes. Osteoarthritis Cartilage, 22(1), 133-44. Retrieved from http://www.oarsijournal.com/article/S1063-4584(13)00999-0/fulltext.
- Fukada, S., Kohsaka, H., Takayasu, A., Yokoyama, W., Miyabe, C., Miyabe, Y., Harigai, M., Miyasaka, N., and Nanki, T. (2004). Cannabinoid receptor 2 as a potential therapeutic target in rheumatoid arthritis. BMC Musculoskeletal Disorders, 15, 275. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243420/.
- 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. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878569/.
- 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 http://www.pnas.org/content/97/17/9561.full.
- 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.
- What Is Arthritis? (n.d.). Arthritis Foundation. Retrieved from http://www.arthritis.org/about-arthritis/understanding-arthritis/what-is-arthritis.php.
- 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.