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Nail-patella Syndrome – Medical Marijuana Research Overview

The following information is presented for educational purposes only. Medical Marijuana Inc. provides this information to provide an understanding of the potential applications of cannabidiol. Links to third party websites do not constitute an endorsement of these organizations by Medical Marijuana Inc. and none should be inferred.

Nail-patella syndrome is a rare genetic disorder that affects 1 in 50,000 individuals. Studies have shown marijuana can help reduce pain and lower the risk and progression of glaucoma and kidney disease associated with the syndrome.

Overview of Nail-Patella Syndrome

Nail-patella syndrome (NPS) is a genetic disorder that causes abnormalities in the nails, and sometimes the knees, elbows and pelvis. NPS is also commonly referred to as Fong’s disease, hereditary onychoosteodysplasia (HOOD), onychoosteodysplasia, or Turner-Kieser Syndrome.

Nearly all individuals with nail-patella syndrome experience abnormalities with their nails, which could be absent, underdeveloped and discolored, ridged, pitted or split. However, some people with NPS will also see have skeletal abnormalities elsewhere. The kneecaps, for example, could be absent, small, irregular shaped or dislocated. The elbows could be angled outward, have abnormal webbing, or not be able to extend fully. Horn-like outgrowths can develop on the pelvis bone. NPS also increases the risk of developing glaucoma because of increased pressure within the eyes and, according to the National Organization for Rare Disorders, 30 to 40% of individuals with NPS will develop kidney disease.

NPS is related to mutations in the LMX1B gene. The mutation is primarily inherited from one affected parent, however, in rare cases, the syndrome develops in people that don’t have the history of the disorder in their family. Imaging tests may allow NPS to be detected prenatally in some cases. Other cases may not be diagnosed until birth or early childhood when nail and other related abnormalities develop.

The treatment approach for NPS can include surgery to replace kneecaps or reconstruct or correct abnormal bones at the knees or elbows. Joint malformations and instability can cause chronic, severe pain, so medications may be used to help manage discomfort. Surgery can also help correct the webbing that can develop at the bend of the elbows. Glaucoma can be treated with medicated eye drops to lower pressure in the eyes. Dialysis or renal transplant may be necessary to address kidney issues.

Findings: Effects of Cannabis on Nail-Patella Syndrome

Cannabis can help those with nail-patella syndrome by managing pain levels and lowering the risk and progression of glaucoma and kidney disease.

Two major cannabinoids found in cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD), are effective at lowering both acute and chronic pain levels1,6. Cannabis has even proven effective at significantly lowering pain that has proven refractory to other treatments4,7,13.

Studies have shown that the two cannabinoids are also effective at decreasing intra-ocular pressure, thus lowering the risk and progression opportunities of glaucoma12. In addition, cannabis features neuroprotection and vasodilation properties, which further assist in the conservative treatment of glaucoma11. The cannabinoids activate the cannabinoid receptors located within the eyes, which are responsible for the formation and outflow of aqueous humor and thus control intra-ocular pressure11.

Evidence suggests that cannabis can promote kidney health. Cannabis has been found to have anti-inflammatory properties, which can help the body in fighting off pathogens and facilitating of tissue repair. CBD can significantly lower oxidative stress and therefore is helpful in a variety of diseases, including diabetes, arthritis, atherosclerosis, Alzheimer’s, hypertension and kidney disease3. Cannabis has been found to have a protective effect on the kidneys in mice with kidney disease2. Rats with kidney injuries were treated with cannabis and experienced significantly less kidney damage5.

States That Have Approved Medical Marijuana for Nail-Patella Syndrome

Currently, only Illinois, Maine and Michigan have approved medical marijuana specifically for the treatment of nail-patella syndrome.

A number of other states will consider allowing medical marijuana to be used for the treatment of nail-patella syndrome with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), 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”).

In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.

In addition, 26 states have approved medical marijuana for the treatment of glaucoma, which can develop into nail-patella syndrome. These states include: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Hawaii, Illinois, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, Ohio, Pennsylvania, Oregon, Rhode Island, Vermont and Washington

Fourteen states have approved medical marijuana specifically to treat “chronic pain,” a symptom that can arise due to joint abnormalities related to nail-patella syndrome. 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 Nail-Patella Syndrome

  • Applying a cannabinoid topically to one eye of rabbits significantly lowered intraocular pressure in that eye as well as the eye that was not treated.
    A submicron emulsion of HU-211, a synthetic cannabinoid, reduces intraocular pressure in rabbits.
    http://link.springer.com/article/10.1007%2Fs004170050361

References:

  1. 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.
  2. Barutta, F., Piscitelli, F., Pinach, S., Bruno, G., Gambino, R., Rastaldi, M.P., Salvidio, G., Di Marzo, V., Cavallo Perin, P., and Gruden, G. (2011, September). Protective role of cannabinoid receptor type 2 in a mouse model of diabetic nephropathy. Diabetes, 60(9), 2386-96. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161308/.
  3. Booz, G.W. (2011, September 1). Cannabidiol as an emergent therapeutic strategy for lessening the impact of inflammation on oxidative stress. Free Radical Biology & Medicine, 51(5), 1054-61. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085542/.
  4. Boychuck, D.G., Goddard, G., Mauro, G., and Orellana, M.F. (2015 Winter). The effectiveness of cannabinoids in the management of chronic nonmalignant neuropathic pain: a systematic review. Journal of Oral & Facial Pain and Headache, 29(1), 7-14. Retrieved from https://goo.gl/R28LWD.
  5. Fouad, A.A., Al-Mulhim, A.S., and Jresat, I. (2012, September 17). Cannabidiol treatment ameliorates ischemia/reperfusion renal injury in rats. Life Sciences, 91(7-8), 284-92. Retrieved from http://www.sciencedirect.com/science/article/pii/S002432051200392X.
  6. Jensen, B., Chen, J., Furnish, T., and Wallace, M. (2015, October). Medical Marijuana and Chronic Pain: a Review of Basic Science and Clinical Evidence. Current Pain and Headache Reports, 19(10), 524. Retrieved from http://link.springer.com/article/10.1007%2Fs11916-015-0524-x.
  7. Lynch, M.E., and Campbell, F. (2011, November). Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. British Journal of Clinical Pharmacology, 72(5), 735-744. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243008/.
  8. Nail-patella syndrome. (2015, September 28). Genetics Home Reference. Retrieved from http://ghr.nlm.nih.gov/condition/nail-patella-syndrome.
  9. Nail Patella Syndrome. (2003). National Organization for Rare Disorders. Retrieved from https://rarediseases.org/rare-diseases/nail-patella-syndrome/.
  10. Naveh, N., Weissman, C., Muchtar, S., Benita, S., and Mechoulam, R. (2000, April). A submicron emulsion of HU-211, a synthetic cannabinoid, reduces intraocular pressure in rabbits. Graefe’s Archive for Clinical and Experimental Ophthalmology, 238(4), 334-8. Retrieved from http://link.springer.com/article/10.1007%2Fs004170050361.
  11. Nucci, C., Bari, M., Spano, A., Corasaniti, M., Bagetta, G., Maccarrone, M., and Morrone, L.A. (2008). Potential roles of (endo)cannabinoids in the treatment of glaucoma: from intraocular pressure control to neuroprotection. Progress in Brain Research, 173, 451-64. Retrieved from http://www.sciencedirect.com/science/article/pii/S007961230801131X.
  12. Pinar-Sueiro, S., Rodriguez-Puertas, R., and Vecino, E. (2011, January). Cannabinoid applications in glaucoma. Archivos de la Sociedad Espanola de Oftalmologia, 86(1), 16-23. Retrieved from http://www.elsevier.es/ficheros/publicaciones/03656691/addon/S036566911000290X/S300/en/296v86n01a90001302pdf001_2.pdf.
  13. Wallace, M.S., Marcotte, T.D., Umlauf, A., Gouaux, B., and Atkinson, J.H. (2015, July). Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. Journal of Pain, 16(7), 616-27. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152762/.
  14. Ware, M.A., Gamsa, A., Persson, J., and Fitzcharles, M.A. (2002, Summer). Cannabis for chronic pain: case series and implications for clinicians. Pain Research & Management, 7(2), 95-9. Retrieved from http://downloads.hindawi.com/journals/prm/2002/380509.pdf.
  • October 6, 2015