58.5 million U.S. adults have arthritis — that’s a quarter of the adult population in the country. And the statistics are only going to continue to grow. The Centers for Disease Control and Prevention (CDC) predicts that 78.4 million adults will be diagnosed with arthritis by 2040.
To complicate matters further, arthritis doesn’t refer to just one type of condition. In actuality, arthritis refers to over 100 different conditions that cause swelling or inflammation of the joints and/or connective tissue. Arthritic conditions include rheumatoid arthritis, osteoarthritis, and psoriatic arthritis. Arthritis is also a common symptom of other autoimmune disorders, such as lupus.
Non-steroidal anti-inflammatory drugs (NSAIDs), anti-rheumatic drugs, and steroids are the most common treatment options for arthritis. While these medicines can effectively reduce inflammation and arthritic pain, many patients still seek alternative adjunct therapies for relief.
Many individuals with arthritis have experimented with cannabis products to decrease pain and inflammation. Arthritis is also a common reason why individuals seek medical marijuana cards in the first place.
What is Arthritis?
Arthritis refers to a set of conditions that cause acute or chronic inflammation of the joints or tissues around the joints. Humans have a lengthy history with arthritis, as it is believed that even the Neanderthals and ancient Egyptians suffered from these conditions.
However, arthritis wasn’t defined until 1886. Over time, more than 100 different types of arthritis have been identified. Osteoarthritis is the most common, which is a non-inflammatory type characterized by a progressive loss of cartilage, leading to bone damage at the joints.
Inflammatory and autoimmune types of arthritis include rheumatoid arthritis, psoriatic arthritis, and gout.
Osteoarthritis v.s. Rheumatoid Arthritis
While osteoarthritis is a non-inflammatory type, rheumatoid arthritis is inflammatory. Furthermore, rheumatoid arthritis is an autoimmune disorder that causes systemic inflammation.
In rheumatoid arthritis, immune cells target the joints and cause an increase in pro-inflammatory cytokines that damage the surrounding tissue. Various genetic and environmental conditions can trigger the inflammatory response observed in rheumatoid arthritis.
Thus, a major component of treating rheumatoid arthritis isn’t just decreasing pain; it also involves reducing the inflammatory immune response. But there must be balance. Decreasing the immune response too much can leave patients vulnerable to other infections and ailments.
Research on Cannabis and Arthritis
In a survey of 1,429 medical marijuana patients, 17 percent reported using cannabis to alleviate their arthritis. 59.8 percent of all participants in the survey said they used cannabis to help reduce their reliance on prescription medications.
Similarly, in another survey of 608 Canadians interested in cannabis, 28 percent reported having arthritis. Seventy-seven percent of all patients in the survey said they felt better after using cannabis for six week.
While these surveys were based on self-reported data, a number of additional studies have also assessed how cannabis affects different types of arthritis. Furthermore, a plethora of research supports the anti-inflammatory effects of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC).
Cannabis and Rheumatoid Arthritis
As mentioned above, rheumatoid arthritis is an autoimmune condition. Thus, treating RA also involves reducing the overactive immune response.
A review published in the Current Opinion in Rheumatology journal describes how cannabis may reduce the inflammatory cytokines caused by rheumatoid arthritis. Specifically, the review describes how activating the CB2 endocannabinoid receptors throughout the immune system can decrease the release of IL-β cytokine proteins.
In mouse models of arthritis, activation of CB2 receptors was associated with a decrease in the progression of rheumatoid arthritis. While activation of CB2 receptors produces anti-inflammatory properties, activation of CB1 receptors can have pro-inflammatory properties.
THC activates both CB2 and CB1 receptors. But it’s important to note that CB1 and CB2 aren’t the only receptors that cannabinoids target throughout the body. In fact, CBD doesn’t really bind to either CB1 or CB2 receptors.
Thus, CB2 activation isn’t the only anti-inflammatory mechanism that cannabinoids possess. Since CBD acts at different receptors in the body, the review suggests that CBD may be more beneficial than THC because it still has anti-inflammatory properties and doesn’t activate CB1 receptors.
Another study found CBD in vitro can effectively decrease cytokine production through its interactions at TRPA1 channels. The authors also explain how the safety and tolerability of CBD also adds to its appeal as an adjunct therapy.
Cannabis and Osteoarthritis
Although osteoarthritis is considered “non-inflammatory,” a review in the Current Opinion in Pharmacology journal explains that osteoarthritic pain is a mix of inflammatory flares, nociceptive, and neuropathic (nerve) pain.
Thus, reducing osteoarthritis symptoms involves decreasing inflammatory flare-ups, reducing the sensation of pain, and alleviating nerve pain.
According to the review, CB1 and CB2 receptors have been identified in the synovial tissue surrounding joints in both mice and humans. Thus, activating CB2 receptors would produce the anti-inflammatory effects described above right at the source of the pain.
While research on cannabis and osteoarthritis is currently ongoing, there have been other studies published on cannabis for reducing neuropathic and inflammatory pain. The review says the results of these other studies “may be translatable to specific OA populations.”
These other clinical studies have found THC effective at reducing both nerve and inflammatory pain in humans.
Topicals, Tinctures, and Arthritis
Now that we’ve established a better understanding of what arthritis is, the different types of arthritis, and the mechanisms behind CBD and THC, which products would make the most sense for joint pain?
Tinctures are a great starting point. They’re easy to accurately dose and use because they come with a dropper. Taking cannabis orally through a tincture allows the cannabinoids to travel throughout your body to produce anti-inflammatory effects.
Cannabis creams for arthritis are another potential option. You can apply topicals directly to your joints for localized pain relief. Additionally, topicals don’t produce psychoactive effects, even if they contain THC.
However, if you’re looking for widespread inflammatory relief, a tincture or an edible would make more sense.
Key Takeaways: Cannabis May Help Alleviate Joint Pain
Arthritis affects a quarter of the adult population in the United States. It produces painful symptoms that can affect your ability to navigate throughout your daily life. Considering that cannabis has known anti-inflammatory compounds, it’s no surprise that patients have started experimenting with cannabis for arthritis.
Several studies and reviews have assessed the potential of THC and CBD to alleviate symptoms of arthritis. They’ve found that THC’s ability to activate CB2 receptors could decrease the pro-inflammatory cytokines associated with rheumatoid arthritis. However, THC’s activation of CB1 receptors may actually increase inflammatory signaling.
On the flip side, CBD has anti-inflammatory properties that don’t involve CB1 or CB2 activation. Thus, experts are looking more toward CBD as a potential adjunct therapy for rheumatoid arthritis.
Conversely, there have been several studies that demonstrate THC may reduce nerve and inflammatory pain, which could be beneficial for patients with osteoarthritis.
Lastly, how you use cannabis affects your experience. If you’re looking for localized pain relief, topicals can be applied directly to your joints. But tinctures and other cannabis products are more useful if you’re looking for more widespread effects.
To learn more about how cannabis could be incorporated in addiction therapy, listen to episode 17 of the Cannabis Science Today podcast. In this episode, host Emily Fata talks to Dr. Peter Grinspoon about his personal story in recovering from an addiction to prescription painkillers. They also discuss the role cannabis could play in addiction recovery.
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- Lowin, T., Tingting, R., Zurmahr, J., Classen, T., Schneider, M., & Pongratz, G. (2020). Cannabidiol (CBD): a killer for inflammatory rheumatoid arthritis synovial fibroblasts. Cell Death & Disease, 11(8). https://doi.org/10.1038/s41419-020-02892-1
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- Lowin, T., Schneider, M., & Pongratz, G. (2019b). Joints for joints: cannabinoids in the treatment of rheumatoid arthritis. Current Opinion in Rheumatology, 31(3), 271–278. https://doi.org/10.1097/bor.0000000000000590