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.
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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.
Medical Marijuana, CBD Oil, and Rheumatoid Arthritis
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Researchers still donвЂ™t know a lot about how marijuana affects your body. But there is substantial evidence that it can help relieve long-term pain. And pain is a major symptom of rheumatoid arthritis (RA).
HereвЂ™s whatвЂ™s known so far about how medical marijuana and a marijuana extract called CBD (cannabidiol) might affect RA.
Benefits for RA
The Cannabis sativa plant has more than 100 chemicals that can affect your body and mind. The two that scientists know the most about are THC and CBD.
THC, or delta-9-tetrahydrocannabinol, is what gets you high when you smoke, vape, or eat marijuana. CBD doesnвЂ™t affect your brain that way. For that reason, some people prefer the oil form of CBD for medical uses.
Rheumatoid arthritis is an autoimmune disease that can make your joints stiff, tender, and painful. RA also can affect your lungs, eyes, skin, and other body parts.
The federal ban on marijuana and CBD means studies on humans have been few. So researchers donвЂ™t know for sure that cannabis eases RA symptoms. But the results from several very small studies suggest that in people with rheumatic diseases, including RA and osteoarthritis, it may help:
- Curb morning pain (but not the overall level of pain)
- Improve sleep
- Lower inflammation in joints (but not joint stiffness)
Some lab testing suggests that cannabinoids may help tamp down the bodyвЂ™s immune response. But the studies have been limited to animals, not humans.
Doctors will need more proof before they can recommend cannabis products to treat rheumatic diseases. For example, we know very little about the effects on RA from smoking marijuana or other uses of herbal marijuana.
Is Cannabis Right for You?
The best way to answer this is to ask your doctor. They can tell you about possible side effects and drug interactions, legal considerations, and which form and at which dose may help you the most.
More than half of the states have legalized marijuana for medical use. More than a dozen other states allow limited medical uses of CBD.
The FDA doesnвЂ™t regulate marijuana or CBD, so you might not know exactly whatвЂ™s in the products you buy. One batch of pot or edible marijuana may have a much higher or lower amount of THC than another, or affect you differently. CBD also can be unpredictable.
Cannabis can affect you mentally and physically. THC can impair driving, so you shouldnвЂ™t get behind the wheel for at least 8 hours after you take it. Smoking or vaping (inhaling) marijuana will hit you more quickly than if you eat it. ItвЂ™s also not good for your lungs or respiratory system.
If you use marijuana regularly, it could make you more likely to get anxiety, depression, and other mental illnesses.
CBD side effects are usually mild or moderate. They can include:
- Dry mouth
- Drop in appetite
- Interactions with blood thinners
Medical marijuana has similar side effects, that may include:
- Increased appetite
- Dissociation (feeling disconnected)
- Dry eyes
Where to Get It
Depending on your state, you may need to buy medical marijuana and CBD at specific dispensaries or pharmacies from approved vendors. Your doctor may need to certify that you have a condition that may benefit from marijuana.
Marijuana is available inВ many forms, like pills, prepared foods, teas, nasal sprays, and as something you smoke or vape.
In some states, CBD is sold at many all-natural food stores and online. It can be taken by mouth as oil or extracts, or applied to your skin.
Chemistry & Biochemistry: вЂњHistory of Cannabis and Its Preparations in Saga, Science, and Sobriquet.вЂќ
Mayo Clinic: вЂњMayo Clinic Q and A: Treatment with medical cannabis,вЂќ вЂњMarijuana,вЂќ вЂњWhat are the benefits of CBD — and is it safe to use?вЂќ вЂњRheumatoid arthritis.вЂќ
News release, The National Academies of Sciences, Engineering, and Medicine: вЂњThe Health Effects of Cannabis and Cannabinoids.вЂќ
Dialogues in Clinical Neuroscience: вЂњCannabis, Cannabinoids, and Health.вЂќ
Arthritis Care & Research: вЂњEfficacy, Tolerability, and Safety of Cannabinoid Treatments in the Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials.вЂќ
Nature Reviews Rheumatology: вЂњCannabinoids for the treatment of rheumatic diseases — where do we stand?вЂќ
U.S. Drug Enforcement Administration: вЂњDrug Scheduling.вЂќ
Cannabis and Cannabinoid Research: вЂњCannabis and Pain: A Clinical Review.вЂќ
Journal of Medical Toxicology: вЂњMedical Marijuana and Driving: A Review.вЂќ
National Center for Complementary and Integrative Health: вЂњMarijuana and Cannabinoids.вЂќ
National Institute on Drug Abuse: вЂњMarijuana as Medicine,вЂќ вЂњMarijuana.вЂќ
You may be wondering if marijuana may ease the pain and discomfort from rheumatoid arthritis. HereвЂ™s what to know.