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Osteoarthritis, the most common type of arthritis, is the wear and tear of joint cartilage. Studies have shown cannabis helps reduce osteoarthritic pain and limit joint damage.
Overview of Osteoarthritis
Osteoarthritis, or degenerative joint disease, is the wearing down of the protective cartilage on the ends of bones. Any joint in the body can be damaged by osteoarthritis, but the disorder most commonly affects joints within the knees, hands, hips and spine.
Cartilage is tissue that allows bones to move about a joint without causing friction. In osteoarthritis, the cartilage becomes rough rather than slick, and eventually wears down completely so that the bones rub against each other.
The symptoms associated with osteoarthritis include pain that develops during or after movement, joint tenderness and stiffness, loss of flexibility, a grating sensation that occurs when the joint moves and the forming of bone spurs around the joint. The affected joints can also become swollen after an extended activity. Over time, the pain and stiffness can become so severe that daily tasks become too difficult.
Osteoarthritis most commonly develops in women and the risk of the disorder increases with age. Being obese places more stress on the weight-bearing joints and can contribute to the development of osteoarthritis. Repetitive stress from work-related or athletic movements, can lead to the disorder.
There is no cure for osteoarthritis and the damage done is irreversible. Treatment, therefore, focuses on slowing the progression of the disease and managing pain.
Findings: Effects of Cannabis on Osteoarthritis
Clinical research analyzing cannabis effect specifically on osteoarthritis is limited. However, studies have demonstrated cannabis’ potent anti-inflammatory and pain-relieving effects, and preclinical studies support the idea that the endocannabinoid system is involved in alleviating osteoarthritis pain (La Porta, et al., 2014). In an animal trial, a cannabinoid found in cannabis, cannabidiol (CBD), was shown to effectively block the progression of arthritis. Researchers found that CBD protected joints against severe damage and concluded that CBD offers a potent anti-arthritic effect (Malfait, et al., 2000). Other studies have found that synthetic cannabinoids offer strong anti-inflammatory and immunosuppressive properties and reduce joint damage in mice with osteoarthritis (Sumariwalla, et al., 2004) (Sumariwalla, et al., 2009).
Pain caused by osteoarthritis can be nociceptive or neuropathic. Cannabis cannabinoids like CBD and tetrahydrocannabinol (THC) activate the CB1 and CB2 receptors of the endocannabinoid system, which have been found to regulate the release of neurotransmitter and central nervous system immune cells to manage both nociceptive and neuropathic pain levels (Woodhams, Sagar, Burston & Chapman, 2015). Activating of the CB1 receptor has been specifically found to reduce pain sensitivity in the osteoarthritic knee joints of rats (Schuelert & McDougall, 2008). Another animal study found that activating CB2 receptors reduces pain and inflammation associated with osteoarthritis (Burston, et al., 2013).
Maintaining healthy bone helps reduce the risk of osteoarthritis and studies have shown that cannabis and its cannabinoids help modulate bone growth and maintenance. By activating the CB1 and CB2 receptors, cannabinoids help manage proper bone formation by restraining bone resorption and enhancing bone formation (Bab & Zimmer, 2008) (Idris, et al., 2009) (Ofek, et al., 2006).
States That Have Approved Medical Marijuana for Osteoarthritis
Currently, no states have approved medical marijuana specifically for the treatment of osteoarthritis. California and New Mexico have approved medical marijuana for all types of arthritis. In addition, in Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment. Plus, various other states will consider allowing medical marijuana to be used for the treatment of osteoarthritis 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 associated with osteoarthritis. 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, 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 Osteoarthritis
Bab, I., & Zimmer, A. (2008). Cannabinoid receptors and the regulation of bone mass. British Journal of Pharmacology, 153(2), 182–188. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219540/.
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.
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/.
Idris, A.I., Sophocleous, A., Landao-Bassonga, E., Canals, M., Milligan, G., Baker, D., van’t Hof, R.J., and Ralston, S.H. (2009, August). Cannabinoid receptor type 1 protects against age-related osteoporosis by regulating osteoblast and adipocyte differentiation in marrow stromal cells. Cell Metabolism, 10(2), 139-47. Retrieved from http://www.cell.com/cell-metabolism/fulltext/S1550-4131(09)00202-2.
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 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC16904/.
Ofek, O., Karsak, M., Leclerc, N., Fogel, M., Frenkel, B., Wright, K., Tam, J., Attar-Namdar, M., Kram, V., Shohami, E., Mechoulam, R., Zimmer, A., and Bab, I. (2006). Peripheral cannabinoid receptor, CB2, regulates bone mass. Proceedings of the National Academy of Sciences of the United States of America, 103(3), 696–701. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334629/.
Osteoarthritis. (n.d.). Arthritis Foundation. Retrieved from http://www.arthritis.org/about-arthritis/types/osteoarthritis/.
Osteoarthritis. (2014, October 9). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/osteoarthritis/basics/definition/con-20014749.
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.
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.