Cannabinoid Therapy for Arthritis

by in Written by Dr. Daniel April 3, 2020

Marijuana for Arthritis?

Arthritis is the leading cause of disability in the United States, affecting over 27 million adults nationwide. The economic, personal, and societal impact is staggering, with the CDC reporting yearly arthritis-attributable medical care costs and earning losses at $303.5 billion

How does arthritis occur and what are the symptoms?

Arthritis involves a diverse group of processes and commonly results in inflammation within one or more joints. The two most common forms of arthritis are osteoarthritis and rheumatoid arthritis, with other forms being autoimmune, infectious, cancerous, or traumatic.

The most encountered form of arthritis is osteoarthritis, which is essentially a degenerative disease of the joint space that occurs with normal wear and tear over time. Weight-bearing joints in the knees and hips are most affected, but osteoarthritis can affect many joints including those in the hands, feet, and spine. The inflammatory pathology of osteoarthritis is driven by a powerful cytokine called interleukin 1a. This interleukin driven (ignore the Klingon warship names here) degenerative erosion of ligaments ultimately leads to the destruction of the bone cells underlying the articular cartilage of the joint where bones meet. Patients suffering from osteoarthritis typically present with symptomatic complaints of pain, inflammation, stiffness, and crepitus (otherwise known as crackling, creaky joints). 

Rheumatoid arthritis, on the other hand, is an auto-immune process in which the body’s own antibodies mistakenly attack the synovial cells that form the inner tissue lining of the joint. This systemic inflammatory disorder is largely driven by interleukin 6 and affects many organs, leading to painful, deformed joints. Patients often report symptoms of early morning stiffness of hands, feet, and the spinal column in the neck.

How does the pathology of arthritis occur?

As cells that form cartilage (chondrocytes) and line the joint (synoviocytes) become damaged, a distress signal is sent to the innate immune system via chemical messengers called cytokines and chemokines. In response, a variety of pro-inflammatory cell types are recruited to the damaged site as part of the normal response to insult in an attempt to limit joint damage and initiate repair, but this adaptive response becomes harmful when inflammation can’t be shut off. As arthritis progresses, the body’s regenerative capacity can’t keep pace with the rate of cellular destruction. A vicious cascade of events ensues, resulting in swelling of the joint and collagen degradation, and the damage to the bony matrix surrounding the joint forms a fibrotic scar.

How does endocannabinoid rescue work for arthritis?

Recall that the entire endocannabinoid system functions to maintain equilibrium, or the body’s natural balance.In other words, the ECS is a ubiquitous biochemical surge protector that evolved to restore natural equilibrium at the cellular level when systems are perturbed.  The cannabinoid entourage of anti-inflammatory and pain reducing compounds interacts with the ECS at this crucial checkpoint to short-circuit this vicious cascade of events.  Specifically, CBD induces the change in chemical signal from a cell-toxic pro-inflammatory signal, to cell growth and survival signal.  

Chondrocytes, the cells that build cartilage, are richly endowed with CB2 cannabinoid receptors. As inflammation progresses, more CB2 receptors are recruited to the surface of the damaged cell, thereby increasing the rate of cannabidiol (CBD) binding and exerting its effects. When CBD binds with these receptors, a reversal of the pro-inflammatory sequence occurs. Cells stop recruiting to the area, swelling goes down, and redness subsides. The body then begins the process of clearing out the inflammatory debris and restoring elasticity to the joint.  

The cannabinoid anti-inflammatory “switch” blocks the effects of prostaglandins driving the pro-inflammatory pathway. This is a very important point to remember because commonly available NSAIDs (advil, ibuprofen, naproxen, aspirin, etc.) and steroids target this exact same pathway. However, all NSAIDs, acetaminophen, and steroids come at the expense of their own toxicity and side effect profile. They can have deleterious effects on the stomach and kidneys in the case of NSAIDs, and toxic liver effects for acetaminophen, which is the leading cause of ED overdose. Steroids also come with their own long list of side effects that can limit their effectiveness.

Emerging scientific cannabis literature.

Cannabis medicines have been shown to reduce joint damage by 70% in chronic arthritis. In addition, cannabinoid medicines address the pain sensation processing known as nociception. Mouse and rat models have shown CBD to be effective at blocking the progression of osteo and rheumatoid arthritis at an optimal dose of 25 mg/kg. That works out to a dose of about 2 grams per day for a 70 kg (154 pound) person. CBD directly modulates the immune system by reducing harmful chemicals tnf-a and ifn-gamma that recruit cells like neutrophils and macrophages that damage the joint. In addition to turning off the destructive pro-inflammatory signals, CBD actually recruits regenerative stem cells (mesenchymal cells) to migrate to the site of injury and differentiate into chondrocytes to rebuild joint tissues. John McPartland summed it up succinctly, “The forces of embryogenesis become the forces of healing after birth.”

Why is it important to talk to your doctor about medical marijuana?

The mainstay of any medical intervention is to treat the underlying cause of symptoms and not just the symptoms of a pathologic process, all while minimizing side effects of treatment. Cannabis can effectively treat the inflammatory and pain symptoms of arthritis, although it is important to note that it does not always address the root cause. Differentiating the exact forms of arthritis is essential, and requires medical training and institute appropriate and timely intervention. For example, some forms of arthritis, like gouty arthritis (gout), are caused by microscopic crystals precipitating in the joint space. This means that gout is effectively treated with targeted medications that lower uric acid levels rather than with cannabidiols. In addition, some joint pains are caused by an infectious agent. These are medical emergencies and require immediate joint drainage and antibiotic therapy to avert permanent damage. 

The take home point is that a trained physician can recognize these different entities and take appropriate action to limit joint damage and maximize symptom relief. Cannabis medicines can be a powerful tool in a patient’s armamentarium if used correctly.

How can ARMMJCards help?

At ARMMJCards, we do far more than certify patients for MMJ cards. We educate patients on how to effectively incorporate cannabis medicines into their comprehensive treatment plan. To learn more or see how you can qualify, visit us here or call 479-308-500.

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