It is currently legal in 37 US states and the District of Columbia. It is becoming more popular, with people being more aware of the options available to them. These include edibles and indica versus traditional sativa strains. People with RA and other rheumatic conditions like RA are keen to try it.
However, what is scientifically proven about cannabis products’ medical use for rheumatic diseases can be summed up in a single head.
This is the conclusion of an article reviewing the state of cannabis research to treat rheumatic disorders. This article was published online in Current Rheumatology Reports on April 29, 2022.
It’s not shocking that there isn’t more information about cannabis
“I was disappointed, but not surprised” at the low quality of research, said W. Benjamin Nowell PhD, director of patient-centered Research at CreakyJoints, and lead author of this review.
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Dr. Nowell states that understanding the medicinal benefits of cannabis is important because patients and doctors are constantly asking the question “whether people should use it to treat pain or sleep disturbances associated with rheumatic diseases.”
Is it possible to reduce pain? Can it improve sleep? Cannabis is a popular choice for people with RA.
CreakyJoints documented the fact that patients with RA are very interested in cannabis several years ago when its patient-centered ArthritisPower Research Registry (where Nowell is a principal investigator) questioned people online.
These results were presented at the 2019 Annual European Congress of Rheumatology in Madrid, Spain. An abstract was published in Annals of the Rheumatic Diseases.
Their use is primarily to treat pain and other symptoms that cannot be treated with other medications. Only 18% of those who tried cannabis claimed that it was the only thing they could do.
Nowell states that rheumatologists often get asked to give guidance about cannabis use due to the increasing interest of people with ankylosing and psoriatic arthritis (AS), and other inflammatory conditions. He says this is crucial because chronic inflammation sufferers often take multiple medications and it’s possible for cannabis to interact with them. The review article revealed that doctors can’t provide complete guidance as there hasn’t been enough high-quality research to support cannabis for pain.
The Legal Status of Cannabis makes it difficult to study
The federal prohibition of cannabis is a major reason for the poor state of research. However, many states have granted it the go-ahead. Nowell states that this makes it difficult for researchers and funders to approve studies and for them to obtain consistent, high-quality cannabis for research.
“I hope the federal government will make some changes, maybe due to increased public pressure from patients or advocacy from physician groups — its current legal status is causing problems. Nowell states that physicians can’t fulfill their oaths without better understanding how the product works.
In recent years, little research has been done on cannabis for joint pain and inflammation.
This review article examines research on cannabis and rheumatoid disorders or symptoms such as pain experienced by many patients with this condition.
Laboratory studies have shown that cannabinoids decrease pro-inflammatory cytokines. Animal studies on mice showed decreased pain and inflammation after cannabis products were used.
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There was one clinical trial that was randomized, which is considered to be the best evidence in medicine. It was limited to 31 patients with RA who were randomized to medicinal cannabis and 27 to placebo. The study found that cannabis had statistically significant effects on pain during movement, rest, and quality sleep. However, it did not have an impact on pain intensity or stiffness.
Nowell states that prospective studies, including randomized clinical trials, are rare and what we need. “Doctors must have good research information to provide to patients. Right now, that’s a huge black hole for rheumatic diseases.”
New Research is underway
According to federal website ClinicalTrials.gov, there are several small studies currently in progress. One study has begun to recruit patients, while another, which tests CBD, is still in the planning stages.
Another Research has Surveyed Cannabis Users
Although some published studies focus on the patient experience, they are not randomised controlled trials. In September 2021, Israeli researchers published in Pain Research and Management that 300 patients who had visited a clinic for rheumatology in the outpatient setting reported significant improvements in their sleep and pain levels. The highest dose, 36 grams, was the most effective at reducing pain by 83 percent.
Chilean researchers also looked at studies on the topic and found one random clinical trial. The rest were patient experiences. They reported in the Journal of Clinical Rheumatology, March 2022, that the evidence was “very uncertain.”
Researchers from Cureus reported that 40 patients suffering from osteoarthritis pain, but not RA, saw their opioid use decline after they began using medical cannabis.
Although results from the second survey on cannabis use by people with chronic inflammatory arthritis (psoriatic or ankylosing spondylitis) have not yet been available, they are being completed.
There were also reports of nausea, constipation, and other negative effects from cannabis.
This review article reveals that cannabis interactions with antidepressants, DMARDs, and gabapentin are not well-studied.
Side effects of cannabis use are also described in this article. These include constipation, fatigue, impaired driving, heart rhythm disturbances, psychosis, and RA.
One Subgroup should Definitely Avoid Medical Cannabis
Nowell states that medicinal cannabis should be avoided by anyone under 25.
Patients feel more at ease when their doctor talks to them about cannabis
Nowell says that people trust their doctors and know their symptoms. Doctors also know their medications so they can discuss this option with them.
ArthritisPower found that 10 percent of those who used medical marijuana quit because their doctor didn’t support it.
Cannabis doesn’t replace a DMARD
This review article contains advice for doctors, based on similar guidance provided by the Canadian Rheumatology Association.
It emphasizes the idea that doctors should talk about the topic in an open and nonjudgmental way, but they should also offer other, more tested options for pain management, such as non-drug methods like cognitive behavioral therapy (CBT), mindfulness, or cognitive behavioral therapy (CBT).
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It also emphasizes the fact that medical marijuana is not a replacement for guideline-based treatments for RA.
Nowell said, despite the fact that there have been no studies on how cannabis affects RA or its symptoms, “I worry that a patient might stop taking something we know is effective in treating the underlying condition, like a prescribed biologic” He says that cannabis should not be used in place of treatment for the condition. Patients should also consult their healthcare provider regarding any other medications.
Nowell states that cannabis is still a popular option for people who are aware of its potential benefits. However, they might consider trying it out with their doctor to alleviate symptoms that have not been resolved by other medications or approaches.
