CBD For Rheumatoid Arthritis
Kimberly is a health and wellness writer with 8 years of experience in healthcare and a special passion for mental health awareness.
Scott J. Zashin, MD, is board-certified in internal medicine and rheumatology. He was a volunteer clinical professor of internal medicine at the University of Texas Southwestern Medical School Dallas.
As cannabidiol (CBD) has grown in popularity over the years, major organizations like the Arthritis Foundation have released guidelines pertaining to its use in the treatment of rheumatoid arthritis (RA). CBD is a non-psychoactive component of cannabis. The CBD in most products is extracted from hemp, a variety of cannabis that only has traces (up to 0.3%) of THC, the active compound that gets people high. Studies have shown CBD can help reduce chronic pain by impacting endocannabinoid receptor activity, which may also reduce inflammation.
CBD comes in different forms, including oil, vape, edible, and topical. Oils, vapes, and edibles are taken orally, while topical CBD lotions can be applied to the skin. CBD dosage varies depending on the form, the indication, and other treatments being used.
What Is Rheumatoid Arthritis?
RA is an autoimmune inflammatory disease, in which the immune system attacks healthy cells in the body and causes inflammation. RA commonly affects joints in the hands, wrists, and knees, causing the joint lining to become inflamed and damaging the tissue. This causes chronic joint pain and leads to deformity. RA can also affect other tissues throughout the body, such as the lungs, heart, and eyes.
Vera Livchak / Getty Images
” data-caption=”” data-expand=”300″ data-tracking-container=”true” />
Vera Livchak / Getty Images
Health Benefits of CBD for RA
Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated with quality studies in humans. Anecdotally, some people who have tried CBD for treatment of arthritis symptoms report noticeable pain relief, improved sleep improvement, and reduced anxiety.
The trials that have been conducted in humans have not yielded strong evidence for the use of CBD in managing arthritic pain.
- A randomized trial of topical CBD for treatment of knee osteoarthritis lasted only 12 weeks, and results were mixed.
- One of the largest reviews examining the health effects of cannabis and CBD concluded that there is substantial evidence that cannabis is an effective treatment for chronic pain in adults. There was, however, no specific conclusion regarding CBD, as definitive studies were not available.
- More recently, a new study showed that CBD can potentially help alleviate RA pain and inflammation by acting on immune cells that are attacking healthy cells in the body. It’s important to note that this study was also not conducted with human subjects.
Research in this area is ongoing.
If you are interested in trying CBD for RA pain management, be sure to talk to your doctor first before using any CBD products.
Rising Popularity of CBD for RA
Based on a 2019 national survey of 2,600 people conducted by the Arthritis Foundation, 79% of respondents said they were using CBD, have used it in the past, or were considering using it to help with their arthritis pain.
Health Benefits Related to Arthritis
Given the lack of strong scientific evidence supporting the use of CBD, it is not recommended as the first choice for pain relief in RA.
If you have RA, you should not stop taking your prescribed medications that may be protecting your joints from future damage. You should discuss any changes you want to make to your medication regimen with your doctor.
Additional Health Benefits
The strongest scientific evidence for effectiveness of CBD as a medical treatment is for seizure prevention in Dravet syndrome and Lennox-Gastaut syndrome, which are severe childhood epilepsy disorders that typically don’t respond to antiseizure medications. Several years ago, the FDA approved the first cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.
Other potential health benefits of CBD include:
- Reduce anxiety, insomnia, and depression
- Relieve cancer or cancer treatment symptoms
- Clear acne
- Slow the progress of neurologic disease like Alzheimer’s disease
Possible Side Effects
Treatment with CBD should be started slowly and under the supervision of a doctor, who will oversee its effectiveness and side effects. There have been reports of mild side effects of CBD.
The most common side effects include:
- Dry mouth
- Low blood pressure
- Appetite changes
It’s important to note that CBD may interact with other drugs, including some of the medications that are prescribed for the treatment of RA.
Warnings and Interactions
There are some warnings and adverse drug interactions to be aware of before beginning using CBD for management of RA-associated pain.
Do not stop taking any other treatments without consulting your doctor. Additionally, CBD shouldn’t be a replacement for other therapies you are using.
Pregnant people and children should consult a doctor before using CBD since there isn’t enough research on the effects of CBD on these populations. There has been concern about a possible link between inhaled cannabis and lower-birthweight babies, but it’s not clear if this applies to CBD.
Currently, the U.S. Food and Drug Administration (FDA) does not regulate the safety and purity of CBD products, so you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. The product may contain other unknown elements. The most effective therapeutic dose of CBD for any particular medical condition has not been established.
Are CBD Products Legal?
CBD products derived from hemp are no longer considered schedule I drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone. There are changes underway on federal and state levels that will ultimately clarify the laws and regulations related to CBD-based products and sales. Despite that, they’re widely available in nearly every state and online. People who want to use CBD should check their own state laws.
Studies have found moderate interactions between CBD and medications commonly prescribed for treating RA.
Interactions can occur with these medications:
- Some antidepressants, including amitriptyline, citalopram, fluoxetine, mirtazapine, paroxetine, and sertraline
- Some medications used for treating fibromyalgia, including gabapentin and pregabalin
CBD can increase your level of coumadin, a blood thinner.
CBD may also raise levels of other medications in your blood by the same mechanism that grapefruit juice does.
Medications that interact with grapefruit juice can potentially interact with CBD, including:
- Cholesterol medications
- High blood pressure medications
- Organ-rejection medications
- Anti-anxiety medications
- Heart medications
- Some antihistamines
Preparation and Dosage
If you’ve decided to try CBD for treating your RA pain, the next step is figuring out how much to take.
Your dosage depends on a number of factors:
- Body weight
- Medical indication
- The concentration and form of CBD that you’re taking
You will likely need to start with a low dose and find what works for you. Studies have found extreme differences in dosages, with some people using 5 milligrams (mg) and others as much as 600 mg.
Your healthcare provider may direct you to start with 20-40 mg per day and increase slowly each day until you feel the relief you’re looking for.
To ensure that you are using CBD safely and effectively for pain management, you should:
- Choose an oral treatment (rather than inhaled products) and start with a low dose
- Establish initial goals of treatment within a realistic period of time. For example, a reduction in knee pain that allows you to walk around the block within two weeks of starting treatment; later, if improved, the goals can be adjusted
- Tell your doctor(s) about your planned and current CBD treatment; monitor your pain and adjust medications with your medical providers, rather than with non-medical practitioners
- When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose
If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, you could consider talking to your doctor about taking CBD with a very low-dose THC product. Be aware that even at low levels, THC may make you feel high, resulting in cognitive, motor, and balance impairment.
If you experience any unwanted side effects when using a CBD product, immediately discontinue use and inform your doctor.
What To Look For
Look for the following when choosing a CBD product:
- Look for products manufactured in the United States with ingredients grown domestically
- Choose products made by companies that follow good manufacturing practices established by the FDA for pharmaceuticals or dietary supplements or required by the state where they are manufactured
- Buy from companies that test each batch and provide a certificate of analysis from an independent lab that uses validated standardized testing methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP), or the Association of Official Agricultural Chemists (AOAC)
- Avoid companies that claim their products have disease benefits
- Be aware that marketers and people behind retail counters are not health professionals. Your doctor is your best source for guidance and monitoring when using an unregulated product
A Word From Verywell
CBD may sound like an appealing option for pain relief, but do your due diligence before jumping on the bandwagon. A lot of people say CBD can help reduce pain and inflammation for those with RA, but not a lot of strong scientific data have substantiated that claim. That said, serious effects are not commonly associated with CBD use.
If this is something you are interested in, you can work with your doctor to figure out whether CBD is something you can try safely. Remember that CBD should not be used as a first-line treatment for RA pain and that it’s not advisable to stop taking disease-modifying treatments for RA.
Cannabidiol, a non-psychoactive component of marijuana, may help to relieve pain and joint stiffness in people with RA. Here’s what you need to know.
Cbd oil for inflammation dosage
What is CBD? CBD, short for cannabidiol, is an active compound found in the cannabis plant. CBD is not intoxicating but may cause some drowsiness. The CBD in most products is extracted from hemp, a variety of cannabis that has only traces (up to 0.3%) of THC, the active compound that gets people high.
Does CBD work for arthritis? Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated in quality studies in humans. Anecdotally, some people with arthritis who have tried CBD, but not all, report noticeable pain relief, sleep improvement and/or anxiety reduction.
Is CBD safe to use? Research evaluating the safety of CBD is underway. At this point very little is known. So far, no serious safety concerns have been associated with moderate doses. CBD is thought to have the potential to interact with some drugs commonly taken by people with arthritis. Talk to your doctor before trying CBD if you take any of the following: corticosteroids (such as prednisone), tofacitinib (Xeljanz), naproxen (Aleve), celecoxib (Celebrex), tramadol (Ultram), certain antidepressants, including amitriptyline (Elavil), citalopram (Celexa), fluoxetine (Prozac), mirtazapine (Remeron), paroxetine (Paxil), sertraline (Zoloft), and certain medications for fibromyalgia, including gabapentin (Neurontin) and pregabalin (Lyrica).
Are CBD products legal? CBD products derived from hemp are no longer considered Schedule I drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone. There are changes underway on federal and state levels that will ultimately clarify the laws and regulations related to CBD-based products and sales. Despite that, they’re widely available in nearly every state and online. People who want to use CBD should check their state laws.
Taking the First Step
Should I give CBD a try? Without quality clinical studies on CBD and arthritis, doctors have not been able to say who might benefit from CBD, at what dose and in which form, who likely won’t benefit and who should avoid it. Still, there is agreement on several points:
- CBD is not a substitute for disease-modifying treatment for inflammatory arthritis.
- Patients who are interested in trying CBD should first talk to the health care provider who treats their arthritis before trying CBD. Together, they can review what has worked or not worked in the past, whether there are other options to try first, how to do a trial run, what to watch for and when to return for a follow-up visit to evaluate the results. Keep a symptom and dose diary to track effects.
- Quality CBD products can be expensive, especially when used for prolonged periods. To avoid wasting money, be completely sure that the product is truly having a positive effect on symptoms.
What type of product should I consider? CBD-based products can be taken orally, applied to the skin or inhaled. There are pros and cons for each.
By mouth. CBD that is swallowed, whether in capsules, food or liquid, is absorbed through the digestive tract. Absorption is slow and dosing is tricky due to the delayed onset of effect (one to two hours), unknown effects of stomach acids, recent meals and other factors.
Capsules can work for daily use after a safe, effective capsule dose has been established. Experts discourage taking CBD via edibles, like gummies and cookies, because dosing is unreliable, and they are appealing to children but do not come in childproof containers. Like any medicine, edibles should be secured out of sight and reach of children.
CBD can also be absorbed directly into the bloodstream by holding liquid from a spray or tincture (a liquid dosed by a dropper) under the tongue (sublingual) for 60 to 120 seconds. The taste may not be pleasant. Effects may be felt within 15 to 45 minutes.
On the skin. Topical products, like lotions and balms, are applied to the skin over a painful joint. Whether these products deliver CBD below the skin is unknown. Topical products may also include common over-the-counter ingredients such as menthol, capsaicin or camphor, making it difficult to determine if a positive effect is due to the CBD or another ingredient.
Inhaled. CBD can be inhaled via a vaporizing, or vape, pen. However, inhalation of vapor oils and chemical byproducts carry unknown risks, particularly for people with inflammatory arthritis. For this reason and because the Centers for Disease Control and Prevention is investigating vaping in association with widespread hospitalizations and deaths from severe pulmonary disease, vaping is not recommended.
How much CBD should I use? While there are no established clinical guidelines, the medical experts consulted by the Arthritis Foundation recommend the following for adults:
- When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose.
- Go low and slow. Start with just a few milligrams of CBD in sublingual form twice a day. If relief is inadequate after one week, increase the dose by that same amount. If needed, go up in small increments over several weeks. If you find relief, continue taking that dose twice daily to maintain a stable level of CBD in the blood.
- If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, talk to your doctor about taking CBD with a very low-dose THC product. Be aware that THC, even at low levels, may get you high, creating cognitive, motor and balance issues. Try THC-containing products at home or at night first, so you can sleep off any unwanted effects.
- After several weeks, if you don’t find relief with CBD alone or with a combination of CBD and very low THC, CBD may not be right for you.
- If you experience any unwanted side effects when using a CBD product, immediately discontinue use and inform your doctor.
What to Look for When Shopping
There is good reason to be a cautious shopper. CBD products are largely unregulated in the U.S. market. Independent testing has shown mislabeling and lack of quality control. The biggest issues are strength of CBD (significantly more or less than the label says), the presence of undeclared THC, and contamination with pesticides, metals and solvents.
- Look for products manufactured in the U.S. with ingredients grown domestically.
- Choose products made by companies that follow good manufacturing practices established by the FDA for pharmaceuticals or dietary supplements (a voluntary quality standard because CBD products are not federally regulated under either category) or required by the state where they are manufactured.
- Buy from companies that test each batch and provide a certificate of analysis from an independent lab that uses validated standardized testing methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP), or the Association of Official Agricultural Chemists (AOAC).
- Avoid companies that claim their products have disease benefits.
- Be aware that marketers and people behind retail counters are not health professionals; they are salespeople. That’s why your doctor is your best source for guidance and monitoring when using an unregulated product.
Our gratitude to the following experts for their guidance and review:
Kevin Boehnke, PhD, a researcher at the Chronic Pain and Fatigue Research Center at the University of Michigan, focuses on medical cannabis as an analgesic and opioid substitute in chronic pain.
Daniel Clauw, MD, a professor of anesthesiology, rheumatology and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center, leads research on arthritis pain and fibromyalgia, and the effects of cannabis, particularly CBD, in pain.
Mary-Ann Fitzcharles, MD, an associate professor of medicine in the Division of Rheumatology at McGill University in Montreal, Quebec, conducts research on pain and rheumatic diseases. She is the lead author of the 2019 Canadian Rheumatology Association (CRA) position statement for medical cannabis.
People with arthritis may consider CBD products for pain relief. Learn what science and experts say about CBD’s benefits, risks, different ways the product can be used and how to be a smart shopper.