Photo by Cristian Newman

Can Cannabis Help with Arthritis?

Aging is a natural consequence of living, but the process comes with aches and pains. Most common among them is arthritis, which currently affects over 20 per cent of Canadians older than 15, making it Canada’s most prevalent chronic health issue.

There are multiple types of arthritis, but no cures, and arthritis sufferers are left to manage symptoms as best they can. For many, cannabis helps.

How can cannabis help with arthritis?

Although most studies are recent, historical evidence suggests that humans have been using cannabis as an arthritis treatment for nearly 3,000 years.

We know now that cannabis contains chemical compounds called cannabinoids, which work by activating the endocannabinoid system, a complex network of cell receptors and molecules that modulate everything from mood to sleep, appetite, motor control, and immunity. The endocannabinoid system also regulates inflammation and pain, the two most prevalent symptoms of arthritis.

Cannabis and arthritis inflammation

Cannabinoids are “potent anti-inflammatory agents,” up to 20 times more effective than aspirin at reducing inflammation, and twice as powerful as hydrocortisone.

Two cannabinoids in particular have captured recent research attention: cannabidiol (CBD) and caryophyllene (a dietary cannabinoid and terpene found in cannabis, black pepper and cloves). Neither CBD nor caryophyllene have psychoactive effects – in other words, unlike tetrahydrocannabinol (THC), a powerful anti-inflammatory in its own right, they won’t get you high.

CBD and caryophyllene work by activating the endocannabinoid system’s CB2 receptors, which are found in tissue throughout the body and involved in regulating inflammation. Research over the years has shown that activating CB2 receptors with cannabinoids can reduce inflammation and slow the progression of certain inflammatory diseases, and a 2014 study published in the Journal of Rheumatology concluded that CB2 receptors offer a “promising therapeutic target for the development of novel pharmacological approaches to treat RA [rheumatoid arthritis].”

Cannabis and arthritis pain

By preventing inflammation, cannabis may also prevent the pain that comes with it. It may also be effective against both acute and chronic pain due to its analgesic, or pain-relieving properties.

A Canadian study, led by McGill University’s Dr. Mark Ware, and the largest ever to consider the long-term safety of cannabis for chronic pain found “no evidence of harmful effects on cognitive function, or blood tests among cannabis consumers and we observed a significant improvement in their levels of pain, symptom distress, mood and quality of life compared to controls.”

South of the border, data from user-reported studies in states that have legalized medical cannabis demonstrate a reduction in the use of opioid painkillers, with patients substituting cannabis instead.

Cannabis and autoimmunity

Studies show that cannabis may be a useful treatment for autoimmune-inflammatory conditions, such as the rheumatoid and childhood variations of arthritis, due to its immunosuppressant qualities. Although hitting the off switch on the body’s immune system is not always desirable, it’s a common treatment for autoimmune disease sufferers, whose conditions are triggered by overzealous immune system that attacks its own tissues.

Cannabis may offer a gentler alternative to commonly prescribed immunosuppressants such as methotrexate, which is essentially low-dose chemotherapy. “Further research of [cannabis] compounds could provide opportunities to treat a large number of clinical disorders where suppressing the immune response is actually beneficial,” says the University of South Carolina’s Dr. Prakash Nagarkatti, who studied cannabis’s immunosuppressant activities.

Cannabis, bone and cartilage health

Although more research is needed, cannabinoids have shown potential for building cartilage, a useful function for patients with damaged cartilage. A 2010 review published in the journal Pharmaceuticals concluded that cannabinoids “provide a dual function” by acting as anti-inflammatory agents as well as regulating stem cell biology and enhancing tissue engineering strategies aimed at cartilage repair.

Other studies on CBD in particular show that the cannabinoid speeds the healing of fractured bones and may reverse bone density loss.

The future of cannabis as an arthritis treatment

We have years of anecdotal support for cannabis as an arthritis medication, and studies that attest to its benefit in reducing pain, inflammation, insomnia and anxiety, among other conditions. But cannabis is still a complicated, and highly personal medicine, and finding the right dose for a particular condition can be a drawn-out process. A Health Canada-approved trial to determine the best cannabinoid ratios and dosages to treat osteoarthritis of the knee is currently underway, and expected to wrap up soon.

“Research has demonstrated the short term efficacy of medical cannabis at reducing pain when used by itself or in combination with other pain-relievers, but comparisons between cannabinoid ratios have not been tested in clinical settings,” reads a press release for the trial.

“We are very pleased to see that the CAPRI clinical trial is underway and beginning recruitment,”continues Joanne Simons, chief mission officer at The Arthritis Society. “We know that many people living with arthritis seek alternative options for pain relief, including medical cannabis. Well-designed clinical research is a prerequisite to get us to where we want to go: more treatment options available to help people manage the pain of arthritis.”