Sjogren’s syndrome is a disorder of the immune system that affects 1-4 million people in the United States. Studies have shown cannabis is effective at reducing pain and may even help regulate the immune system.
Overview of Sjogren’s Syndrome
Sjogren’s syndrome is an autoimmune disorder that is nearly always associated with dry eyes and a dry mouth. The syndrome causes the mucous membranes and moisture-secreting glands of the eyes and mouth to decrease production of tears and saliva.
Sjogren’s syndrome, which typically affects women over the age of 40, is classified as an autoimmune disorder because the immune system mistakenly attacks healthy cells and tissues. Why someone develops Sjogren’s syndrome is still unknown, although according to Mayo Clinic, certain genes put people at a higher risk. A triggering event, like an infection, is seemingly necessary. In the syndrome, the immune system attacks healthy cells in the moisture-secreting glands of the eyes and mouth. It can also target, however, joints, nerves, lungs, kidneys, skin, and the liver and thyroid.
In addition to dry mouth and eyes, Sjogren’s syndrome also commonly causes joint pain and swelling, swollen salivary glands, skin rashes or dry skin, vaginal dryness, persistent dry cough and prolonged fatigue. Sjogren’s syndrome can lead to further complications, like dental cavities, yeast infections and vision problems.
There is no cure for Sjogren’s syndrome, so the focus of treatment is to manage associated symptoms. Medications are used to increase saliva production and manage pain. Nonsteroidal anti-inflammatory drugs are used if arthritis develops. Eye drops can be used to relieve dry eyes.
Findings: Effects of Cannabis on Sjogren’s Syndrome
Cannabis can help those with Sjogren’s syndrome manage their pain. Two of the major cannabinoids found in cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD), have been found to be effective at lowering pain levels associated with various acute and chronic conditions, including some cancer, neuropathy, spasticity, headache, and migraines (Jensen, Chen, Furnish & Wallace, 2015) (Baron, 2015). THC and CBD are agonists of receptors CB1 and CB2 of the endocannabinoid system. They activate the receptors, which in turn regulate the release of neurotransmitter and central nervous system immune cells to manage pain levels (Woodhams, Sagar, Burston & Chapman, 2015).
Research also suggests that cannabis may contribute to regulation of the immune system and prevent it from attacking as many healthy cells. Activating the CB1 and CB2 receptors, some of which are found on the cells of the immune system, stimulates a response that suppresses the immune system. Studies have shown that when cannabinoids stimulate CB1 and CB2, cytokine and chemokine production is downregulated and t-regulatory cells are upregulated (Nagarkatti, et al., 2009).
Cannabis can also offer therapeutic benefits to Sjogren’s syndrome patients that have rheumatoid arthritis or lupus. CBD has been shown to reduce joint inflammation and inhibit the progression of arthritis (Sumariwalla, et al., 2004) (Nagarkatti, et al., 2009). Cannabis has shown it reduces pain associated with inflammatory diseases like lupus. Receptors CB1 and CB2 are involved in the mediation of pain caused by inflammation, so as the cannabinoids act upon the receptors, pain decreases (Clayton, Marshall, Bountra & O’Shaughnessy, 2002) (Elikotti, Gupta & Gupta, 2009).
States That Have Approved Medical Marijuana for Sjogren’s Syndrome
Currently, only the state of Illinois has approved medical marijuana specifically for the treatment of Sjogren’s syndrome. 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 Sjogren’s 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”).
Several states have approved medical marijuana specifically to treat “chronic pain,” a symptom associated with Sjogren’s 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, 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.”
In addition, Illinois and New Hampshire have approved medical marijuana for the treatment of lupus, and California, Illinois and New Mexico have approved medical marijuana for rheumatoid arthritis; both conditions often develops alongside Sjogren’s syndrome.
Recent Studies on Cannabis’ Effect on Sjogren’s Syndrome
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.
Clayton, N., Marshall, F.H., Bountra, C., and O’Shaughnessy, C.T. (2002, April). CB1 and CB2 cannabinoid receptors are implicated in inflammatory pain. Pain, 96(3), 253-60. Retrieved from http://journals.lww.com/pain/pages/articleviewer.aspx?year=2002&issue=04000&article=00005&type=abstract.
Elikkottil, J., Gupta, P. and Gupta, K. (2009, November-December). The analgesic potential of cannabinoids. Journal of Opioid Management, 5(6), 341-57. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728280/.
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.
Nagarkatti, P., Pandey, R., Rieder, S.A., Hegde, V.L., and Nagarkatti, M. (2009, October). Cannabinoids as novel anti-inflammatory drugs. Future Medicinal Chemistry, 1(7), 1333-49. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828614/.
Sjogren’s syndrome. (2014, July 8). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/basics/definition/con-20020275.
Sumariwalla, P.F., Gallily, R., Tchilibon, S., Fride, E., Mechoulam, R., and Fedmann, 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.
What is Sjogren’s Syndrome? (2012, October 15). National Institute of Neurological Disorders and Stroke. Retrieved from http://www.ninds.nih.gov/disorders/sjogrens/sjogrens.htm.
Ware, M.A., Doyle, C.R., Woods, R., Lynch, M.E., and Clark, A.J. (2003, March). Cannabis use for chronic non-cancer pain: results of a prospective survey. Pain, 102(1-2). Retrieved from http://journals.lww.com/pain/Abstract/2003/03000/Cannabis_use_for_chronic_non_cancer_pain__results.23.aspx.
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.