Arthritis is one of those conditions that will inevitably affect a large proportion of us. According to statistics from the Centers for Disease Control and Prevention, in the United States one in ten of the population live with some form of arthritis, making it the biggest cause of disability.
While there are over 100 types of arthritic diseases, the most common are Osteoarthritis and Rheumatoid Arthritis. Both conditions share pain and inflammation as their symptoms, but their causes are very different – Osteoarthritis caused by joint wear and tear, and Rheumatoid Arthritis – an autoimmune disease in which the body attacks the lining of the joints.
But in the area of cannabinoid research, scientists believe that cannabis may show potential as an alternative to prescription medication for sufferers of both conditions; welcome news to the many who struggle with the unpleasant side effects associated with long term use.
Endocannabinoid System – the body’s natural pain and inflammation regulator
This is partly based on an ever growing understanding of the Endocannabinoid System (ECS) – the body’s complex network of receptors and cannabis-like compounds that modulate everything from mood, sleep, appetite, the immune system and crucially pain and inflammation.
The ECS comprises two main types of receptors: the CB1 receptors which are found mostly in the central nervous system and the CB2 receptors in body’s periphery. However, it is the CB2 receptors that scientists are most interested in as a potential therapeutic target for arthritic conditions because they are most implicated in the inflammation response and the immune system.
A scientific paper published in the Journal of Rheumatology found that CB2 receptors were found in unusually high density in the joint tissue of Rheumatoid Arthritis (RA) patients, which were believed to be an active response by the ECS to reduce inflammation.
And scientists in another study also noted the presence of the body’s natural cannabis compounds, Anandamide and 2-AG in arthritis patients’ joint fluid, which while absent in healthy joint tissue, suggests further anti-inflammatory activity of the ECS.
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Cannabinoids – nature’s anti-inflammatory solution?
So with the Endocannabinoid System playing a crucial role in pain and inflammation, it’s no wonder scientists are keen to see if plant cannabinoids, namely THC (Tetrahydrocannabinol) and CBD (Cannabidiol), can produce a similar effect.
THC’s ability to bring about cell death or apoptosis has been much talked about in the field of cancer. But it could also explain why THC has an anti-inflammatory effect in Rheumatoid Arthritis. By provoking the death of out of control immune cells that are attacking the body, THC can restore balance to an overactive immune system. CBD also acts alongside THC thanks to its anti-proliferative action, whereby activated immune cells are prevented from spreading, all of which is ultimately anti-inflammatory.
Both cannabinoids reduce the production of pro-inflammatory cytokines, the signalling proteins made by immune cells that are overproduced in patients with autoimmune diseases such as Rheumatoid Arthritis. According to Biochemist Dennis Hill, who himself claims to have cured himself from cancer through cannabis, “Phytocannabinoids have the ability to suppress this inflammatory cytokine cascade by inhibiting glial cell production of the cytokines interferon or interleukin.” He goes on, “here we see the seeds of chronic inflammation dissolved by the modulation process of cannabinoids bringing homeostasis to systems out of balance.”
The antioxidant effect of THC and CBD is also thought to reduce inflammation and pain, which can occur as a result of oxidative stress to the body. In a study on CBD as a therapeutic agent for chronic inflammation and neuropathic pain, scientists statied they could not “exclude that the anti-hyperalgesic effect of cannabidiol is due to its well-known antioxidant properties.”
CBD – a complex mechanism of pain regulation
Another reason why CBD may be effective at reducing pain, is its unique relationship with non-cannabinoid receptors in the body. Unlike THC, which fits snuggly into the CB1 receptors in the central nervous system, CBD doesn’t interact directly with either endocannabinoid receptor. What scientists are gradually realising is that CBD does have binding affinity with other receptors that are not part of the ECS, but may have a pain relieving or anti-inflammatory effect on the body.
Take for instance the Vanilloid receptor (TRPV-1), known to mediate pain perception, inflammation and body temperature. Both CBD and anandamide are TRPV-1 agonists, meaning they stimulate the receptor, and it is believed this could explain why the non-psychoactive cannabinoid can be so helpful for neuropathic pain.
Scientists have also found that administering CBD to patients, increases levels of anandamide in the body. Normally anandamide is broken down quickly by the Fatty Acid Amide Hydrolase (FAAH), but CBD actually reduces FAAH production, resulting in higher anandamide levels and greater anti-inflammatory/ pain relieving endocannabinoid activity.
CBD and Rheumatoid Arthritis – real life stories
Someone who has experienced firsthand the pain relieving effects of CBD is 82 year old, British grandmother, Phil Schwarz. Phil has lived with Rheumatoid Arthritis for the last 40 years and like most RA sufferers, has been prescribed various immunosuppressant and pain killing drugs. But of late none of them could kept her painful RA flare ups in check.
A member of Phil’s close family had spoken to her about how CBD might help with the unbearable pain she’d been experiencing. So after consulting with her Rheumatologist, Phil decided to start taking CBD drops.
A few months on, Phil feels like she has a new lease of life. “I’ve just been out and I’ve walked about ¾ of a mile,” she says, “before I couldn’t do about a hundred yards. It’s like a miracle worker, and I don’t care if it’s in my head or in a bottle, whatever it is, it’s doing it.”
But it’s not just the elderly who are affected by Rheumatoid Arthritis. Cleo Bella, at just 11 was diagnosed with Polyarticular Rheumatoid Arthritis and according to her mother, “at times couldn’t walk at all because of the pain. Her fingers were swollen and painful, making it hard to write or draw. Cleo needed help with almost every major task to function properly.”
Cleo’s mother also turned to CBD for her daughter. Within just 2 weeks of taking CBD she recalls, “Cleo’s appetite came back and she started gaining weight, the grey was gone and the pink in her skin came back, the swelling in her knees decreased by half making the swelling noticeably better and stunning her physical and occupational therapists.”
Anecdotal reports like Phil’s and Cleo’s abound. But what about any clinical studies proving that medicinal cannabis can help arthritis?
A preliminary assessment of the efficacy, tolerability and safety of the cannabis-based medicine Sativex in the treatment of pain caused by rheumatoid arthritis was carried out in 2006. Sativex, made by GW Pharma contains approximately a 1:1 ratio of CBD and THC and is generally prescribed for the spasticity and pain associate with Multiple Sclerosis.
According to the study’s findings, “in comparison with placebo, the CBM (cannabis based medicine) produced statistically significant improvements in pain on movement, pain at rest, quality of sleep.” The report continues, “a significant analgesic effect was observed and disease activity was significantly suppressed following Sativex treatment. Whilst the differences are small and variable across the population, they represent benefits of clinical relevance and show the need for more detailed investigation in this indication.”
With encouraging results like this, one would imagine that some follow up trials would have taken place. But to this date there have been no further clinical trials on Sativex for Rheumatoid Arthritis.
However, a current study is underway at Dalhousie University in Canada, backed by the Arthritis Society, testing vaporized cannabis medication on patients with osteoarthritis of the knee. Under lead researcher Dr Jason McDougall, the team will be looking at the anti-inflammatory and pain relieving action of cannabis on osteoarthritis, but also hope to show that cannabinoids in the plant may actually be able to repair the joint.
McDougall says, “[The nerves are like] wires that have been stripped of their coating. They’re all bare, they’re all raw and responsible for feeling a lot of pain. What we hypothesize is that by locally administering these cannabis-like molecules to those nerves, we’d actually be able to repair them and reduce the pain of arthritis.”
But whether this trial is successful or not, it’s strikingly clear that few clinical trials exist to back up what scientists have found in the lab, and many people know from personal experience – that medical cannabis could be a safe and effective treatment for arthritic pain and inflammation for millions of people worldwide.