Autoimmune rheumatic diseases are complex. Living with an autoimmune rheumatic disease involves more than physical symptoms, impacting one’s quality of life, mental health, and daily activities.
The most well known form of rheumatism is rheumatoid arthritis (RA), an autoimmune and inflammatory disease where one’s immune system attacks healthy cells in the body, causing painful inflammation. RA effects mainly the joints and typically many joints at once. The lining of the joint becomes inflamed, causing damage to the tissue and long-term chronic pain, loss of balance, and deformity. RA can also affect other tissues throughout the body and cause problems in organs such as the lungs, heart and eyes.
Childhood arthritis is also known as Juvenile idiopathic arthritis (JIA). While children often outgrow it, the early onset of damage can make it hard for a child to do everyday activities such as walking or dressing and may result in a disability. Even with potentially achieving permanent remission, any physical damage to the joint may remain.
As of today, there is no cure for this autoimmune disease and symptoms are addressed on an individual basis. Recommendations for combination therapies include:
- Increasing physical activity/muscle strengthening exercises
- Weight loss
- OTC pain relievers
- Crutches/canes
- Surgery, if all other resources are exhausted
- And, more recently researched, cannabinoid therapy
The Endocannabinoid System (ECS) and RA
To understand the role of the ECS in RA, Richardson et al. examined the synovial fluid of 32 osteoarthritis patients and 13 rheumatoid arthritis patients following knee arthroplasty. The endocannabinoid 2-Arachidonoylglycerol (2-AG) and cannabinoid receptors 1 and 2 (CB1 and CB2) were present in the synovia of patients with end-stage osteoarthritis and rheumatoid arthritis, but not in healthy donors. These findings suggest that the ECS is involved in the development of rheumatic diseases.
Cannabinoids and Pain
A characteristic of rheumatism is chronic pain, where adequate treatments fall short. Therefore, there is a strong need for alternative therapies. Medicinal cannabis extracts on chronic pain have been evaluated across several trials. Statistically significant improvements have been observed with delta-9-tetrahydrocannabinol (THC) extracts as well as a combination of cannabinoid (CBD) to THC on RA patients, with only mild side effects. In addition to pain, patients reported improvements for sleep quality.
A review of clinical trials of pain reduction by cannabis show that cannabis-based medications were most effective as adjunct therapy in multiple sclerosis and in managing chronic rheumatoid pain.
A 2021 analysis of 29,000 patients, where 10,873 were cannabis users concluded that about 20% of patients with rheumatoid diseases who actively consume cannabis self-reported an improvement in pain.
Cannabinoids for Immunomodulatory Effects
Cannabinoids mediate their therapeutic effects through CB1 and CB2 receptors located throughout our brain and body.
The fact that both CB1 and CB2 receptors are expressed by immune cells suggests that cannabinoids play important roles in the regulation of the immune system. Cannabinoids are commonly investigated as pain-relieving agents, but in recent years more evidence has accumulated on their potential immunomodulatory effect, supported by results in animal models of certain rheumatic diseases.
Many studies point to CBD for its ability to reduce the formation of reactive oxygen species and nitric oxide in animal models of inflammation. One study noted CBD to have a “potent capacity to effectively suppress cytokine storms in a mouse model” (Aswad et al., 2022). Further evidence on cannabinoids and the immune system looks to THC and its ability to aid in preventing the activation of inflammatory signaling pathways.
Cannabinoids as anti-inflammatories
CBD has a wide spectrum of biological activity, including anti-inflammatory activity. This is why its activity in the prevention and treatment of diseases whose development is associated with inflammation has been tested. Clinical studies have confirmed that CBD reduces the levels of proinflammatory cytokines, inhibits T-cell proliferation, induces T-cell apoptosis and reduces migration and adhesion of immune cells.
In addition, CBD creates a physiological response with several inflammatory mediator receptors within us. These are known as the PPARy, GPR, and Adenosine A2A Receptors.
The anti-inflammatory contributions of THC are also notable. In 1991, Evans demonstrated that THC has twenty times the anti-inflammatory potency of aspirin and twice that of hydrocortisone.
Takeaway
Cannabinoids show promising results for anti-arthritic properties, notably due to their analgesic, immunomodulatory, and anti-inflammatory actions. However clinical studies for RA specifically and studies focusing on commercially available products are limited. The cannabis plant contains hundreds of compounds, including various cannabinoids, terpenes, and flavonoids. Specific strains may benefit some conditions more than others and only further research will build this understanding so patients may have more accurate, targeted therapy.
To join research, receive updates on cannabis education, or to chat with our care team to discuss anything cannabinoid therapy related one on one, contact Realm of Caring today.
Additionally, following Realm of Caring on social media (Instagram or Facebook) during Autoimmune Awareness Month can provide valuable insights and foster a supportive community for those affected.
if you want to reach out to our care team to discuss anything cannabinoid therapy related one on one – we are here for you! You can email or call our care team directly or head to our contact us section to schedule an appointment.
