About 54 million adults and 300,000 children have been diagnosed with some form of arthritis in the US, while. globally, we are looking at closer to 350 million people suffering with arthritis, and these numbers are only expected to increase. Quality of life for arthritic patients is often fraught with pain, stiffness, limited mobility, and decreased movement within the joints. Current treatments often have undesirable side-effects which make CBD more attractive as an alternative treatment for the patient with arthritis pain and inflammation. Currently, the largest group of cannabis users are arthritis sufferers.
What Does Having Arthritis Mean?
Arthritis is inflammation of a joint or of multiple joints. While arthritis means joint inflammation, the term describes any one of over 200 similar illnesses of inflammation that affects the joints, cartilage, tissues around the joints and connective tissues.
CBD is known to reduce inflammation and the pain that comes with inflammation. CBD could theoretically be useful for all forms of arthritis. This includes forms of systemic arthritis associated with autoimmune diseases such as Sjogren’s Syndrome and scleroderma, a type of autoimmune rheumatoid arthritis.
Systemic arthritis exerts its effects beyond the joints to the eyes, tissues, organs, and other parts of the body. This is seen most commonly in the autoimmune condition, rheumatoid arthritis. CBD could be especially useful in systemic arthritis since it interacts with the endocannabinoid system and receptors for cannabinoids exist throughout the body and brain as part of the endocannabinoid system.
What Are the Most Common Forms of Arthritis?
The two most common forms of arthritis are osteoarthritis and rheumatoid arthritis with osteoarthritis, also known as degenerative joint disease, being the most common form. Other forms that arthritis can take include bursitis, certain types of back pain, gout, Lupus, fibromyalgia, stenosis and Sjogren’s Syndrome.
Osteoarthritis
In this type of arthritis, the cartilage gradually erodes leaving bone to rub on bone, which in turn creates inflammation and pain. Cartilage is the slippery, cushioning material on the end of bones. Athletes are at high risk for this type of arthritis due to having anterior cruciate ligament or ACL tears. Other risk factors for osteoarthritis include age, excess weight, and genetic history.
Osteoarthritis can be avoided by staying active, maintaining a healthy weight, preventing injuries, and avoiding repetitive movements.
It was in 2014 in Barcelona, Spain that researchers found increasing evidence from preclinical studies that pointed to the endocannabinoid system as a therapeutic target for osteoarthritis pain. CBD affects the endocannabinoid system, a complex network of cannabinoid receptors (primarily CB1 & CB2), molecules and enzymes that work in concert to create balance in the body. The endocannabinoid system includes the body’s own two cannabinoids, anandamide and 2-AG.
Rheumatoid Arthritis
Rheumatoid arthritis is a form of autoimmune disorder where the immune system attacks the lining of the joint capsule causing swelling and inflammation. This type of destruction can destroy the cartilage and bone in the joint capsule leading to further inflammation and pain.
A recent 2019 study suggested the use of CBD in arthritis but cautioned that the right receptors need to be targeted. A combination of CB1 antagonist and CB2 agonist receptors was suggested and also CBD specifically for its cannabinoid receptor independent anti-inflammatory action. A receptor agonist promotes the activity of that receptor while an antagonist prevents the receptor from carrying out its functions.
A recent case report of a 50 year old woman with rheumatoid arthritis and autoimmune diseases was treated with 200 mg CBD isolate three times daily and a reduction in pain and stiffness was noted after 72 hours with full therapeutic effect gained at day 10. Lab blood analysis showed a decrease in inflammatory markers by day 28 which further substantiated the patient’s self-report of pain relief. Adverse effects were limited to mild esophageal irritation from drinking the CBD tincture.
Current Arthritis Treatments
Current therapies for arthritis include nonsteroidal anti-inflammatories (NSAIDs), cortisone, narcotics, counterirritants (preparations that interfere with pain signals such as menthol), disease modifiers and biologic response modifiers. Adverse side-effects exist for all these therapies except for counterirritants, which is a category CBD topicals would fall into. For example, NSAIDS may lead to acute kidney injury and gastrointestinal bleeding. Immunosuppression and gastrointestinal bleeding are common side effects of cortisone. Current accepted therapies come with many side-effects.
CBD and Arthritis Pain
Those who use CBD for arthritis are increasing and according to a recent conference survey, over 60% reported using CBD. This is despite a lack of clinical evidence for its therapeutic use for this condition. Research on animals is promising, however, on potential applications of CBD to the alleviation of pain associated with arthritis in humans.
CBD both silences the CB1 receptor while activating the CB2 receptor that is widespread in the immune system. By doing this, it affects the inflammation in arthritis that is causing pain and may even influence the pain signaling itself.
What do the Studies Say About CBD and Arthritis?
Evidence shows us that the endocannabinoid system (ECS) functions in humans and animals both in the joint and joint capsule. We also know that CB1 and CB2 receptors for cannabinoids are widespread throughout the joints and blood supply to the joint. If CBD influences the joints and microvasculature, then it theoretically may be used to prevent arthritis pain and disability in humans.
A 2014 review suggested the benefits of cannabinoids in treating the pain of arthritis.
A 2017 animal study showed the benefits of CBD in treating osteoarthritis. The study concluded that CBD may be beneficial in treating neuropathic pain found in 30% of osteoarthritic patients who do not tolerate first and second-line drug therapy. Furthermore, it was stated that several cannabis products were neuroprotective in nature to musculoskeletal disorders thus highlighting the role of CBD as a neuroprotectant in osteoarthritis.
Transdermal Application of CBD for Arthritis Pain
One animal study utilized a transdermal delivery mechanism for CBD in rats that had arthritis induced. The treatment with CBD reduced the inflammation and hypersensitivity to pain. Transdermal gel significantly reduced joint swelling and indicators of pain at 6.2 and 62 mg/day in a dose-dependent manner.
Local Application of CBD for Arthritis Pain
According to the results of this study, local application of a 10% CBD gel on the skin directly laying over an inflamed joint in patients would potentially increase CBD concentrations and promote effectiveness without systemic effects. Not only would the treatment reduce inflammation, but it would serve as a protectant for the nerves as well.
In another study on the same animal model, a significantly higher oral dose was required to achieve the same effects, 5 mg/kg. Curiously, a bell-shaped dose curve was noted with both the lower and higher amounts showing less effect than the dose in the middle. It would be interesting to know whether a full- spectrum or isolate was used in the study since the absorption patterns differ.
Can CBD Studies on Animal Dosages Relate to Human Dosages?
While we cannot extrapolate dosages from animal models to humans, we can take note of trends in dosages and how CBD functions biochemically.
Currently, with the knowledge that cannabinoid receptors are located throughout the body for both animals and humans and the endocannabinoid system is highly involved in the regulation of inflammation and pain, it is no wonder we are excited about the potential therapeutic uses of CBD for arthritis. One main roadblock to an official use of CBD oil for arthritis is the lack of evidence-based dosage guidelines which will only come with further clinical trials that show the benefit of CBD for arthritis in humans and dosage guidelines to follow.
How Does CBD Work in Arthritis Relief?
Phytocannabinoids essentially influence the inflammatory responses by regulating the production of chemicals called cytokines or signals that are released after tissue injury. There are 4 basic mechanisms that CBD influences to reduce the arthritis pain and inflammation. They are:
4 CBD mechanisms in reducing arthritis pain and inflammation
The primary mechanism of action for CBD in reducing pain is the reduction of the inflammation causing the pain. There is limited evidence that CBD directly blocks the pain signaling response.
We know that:
- CBD induces apoptosis (programmed cell death),
- inhibits cell proliferation,
- suppresses inflammatory cytokine production and
- induces the T-regulatory cell pathway.
These are all hallmark metabolic pathways involved in inflammation.
CBD’s actions on receptors and metabolites
In addition, CBD is a CB2 receptor agonist, prevents the degradation of the body’s own endocannabinoid, anandamide, and releases arachidonic acid metabolite by products. Arachidonic acid causes inflammatory mediators to be released thus aggravating the arthritic process and increasing pain.
An animal study revealed that CBD blocked the pain signals at the level of the GPR55 receptor. This receptor was once thought of as the CB3 receptor. It is a cannabinoid receptor.
Can CBD Prevent Arthritis?
Anandamide, one of the body’s own endocannabinoids, helps fight pain. CBD interferes with the enzymatic degradation of this endocannabinoid thus indirectly alleviating pain by increasing the action of this pain fighting molecule.
CBD also acts via the entourage effect to create an anti-inflammatory response in the body utilizing the synergistic actions of other natural cannabinoids, terpenes, and flavonoids, all of which have anti-inflammatory actions of their own. The entourage effect is the synergistic interactions of all the chemicals in the cannabis plant working together to create a greater effect through combination of all the cannabinoids, terpenes, flavonoids and other molecules in the cannabis plant.
CBD Products for Arthritis
Using CBD topical lotion for arthritis
Topical ointments and creams for arthritis are frequently combined with synergistic essential oils that have anti-inflammatory or numbing pain-relieving effects such as menthol, camphor, or tea tree oil. These oils need to be diluted in a carrier oil so as not to burn the skin, so they are frequently combined with a moisturizing oil such as jojoba or olive oil. The combined effects of CBD and the essential oil produces an additive effect on inflammation reduction and pain relief.
Topical lotions for pain relief may be found here. CBD topical salve and muscle rub are both available for use on sore, arthritic joints and muscles.
Oral use of CBD oil for arthritis
Oils exist in a concentrated form and can be consumed orally or inhaled by vaping. Dosages for oils that are inhaled are frequently lower than those needed to achieve the same effects when taken orally. Oils that are taken under the tongue need to be held for 60 seconds for optimum absorption. Blood levels after oral use are reached 60-120 minutes after use while effect duration varies from 8-20 hours.
Tinctures and gel caps may be found here.
Pulmonary use of CBD for arthritis
Peak value is generally reached within 10 minutes of inhalation and maintains a steady state for 3-5 hours. A major limitation of inhaling is the inter-patient variability of factors such as the amount of vapor inhaled, time held, and product used.
Whole Hemp vs. Isolated CBD
Whole hemp contains other molecules called terpenes and flavonoids that have a synergistic effect on CBD increasing therapeutic outcomes by complementary mechanisms or increasing CBD’s bioavailability. Many terpenes have anti-inflammatory, pain reducing effects of their own making whole hemp a more viable choice due to what we call the entourage effect, as previously stated, working with the synergistic effect of all molecules in the hemp plant.
Considerations Before Taking CBD
The Food and Drug Administration (FDA) does not recognize or approve of CBD as a treatment for arthritis (yet). It is only approved to treat two forms of epilepsy and comes in a prescription form called Epidiolex.
FDA wants more clinical evidence before approving CBD for use in other conditions. Such clinical evidence is lacking primarily due to the previous legal status of CBD. In 2018 the passing of the Farm Bill legalizing hemp for public use was enacted. Hemp is less than 0.3%
THC but contains other cannabinoids, including CBD. CBD is not psychoactive like THC nor does it have addictive properties. Now that the law is on the side of CBD, more clinical studies are expected in the very near future.
Minor side effects may be noted such as fatigue, diarrhea, changes in appetite or changes in weight. These have not been significant and have not led to study participants withdrawing from clinical trials.
While CBD is a safer alternative to most of the drug treatments, we currently have in use to treat arthritis, there are some things to consider. There may be drug-drug interactions with the use of CBD since many drug detoxification pathways use the same pathways as CBD. There is also a tremendous lack of regulation in quality control when it comes to manufacturing the product. Always buy a product produced under Good Manufacturing Practices that contain a Certificate of Analysis performed by a third party lab. Not only have molecular concentrations of CBD been inaccurate on labels, there is a concern for the concentration of such things as heavy metals (i.e. lead), microbes (i.e. Aspergillus mold), pesticides and mycotoxins. Therefore, we need standardization in quality control of this product. And, a third party lab, not the manufacturer, should be doing the quality control testing. Finally, patients should be using mostly hemp based products according to the Arthritis Foundation Guidelines for CBD.
While animal studies are promising, more human clinical trials are needed before treatment recommendations can be evidence-based.
