CBD and Rheumatoid Arthritis

Rheumatoid arthritis is a debilitating disease that affects more than one million Americans. It can cause chronic pain and permanent joint damage if it’s not diagnosed early and treated aggressively.

Aside from physical pain, this disease can also take a mental toll. Those with rheumatoid arthritis are more likely to experience symptoms of depression and frequently miss work.

Cannabidiol (CBD) is an affordable and accessible health supplement that may offer relief from painful rheumatoid arthritis symptoms. In this article, we’ll discuss the causes of rheumatoid arthritis, how CBD targets the source of this disease, and the scientific evidence for CBD as an effective arthritis treatment. We’ll also answer some of your most frequently asked questions when it comes to trying CBD for the first time.

Rheumatoid Arthritis: What You Need to Know

Rheumatoid arthritis (RA) is an autoimmune disorder that affects the joints. RA symptoms most commonly appear in the hands, wrists, elbows, knees, ankles, and feet.

Approximately 1.5 million people in the United States suffer from RA. While RA affects both men and women, women are three times more likely than men to be diagnosed. In women, RA symptoms usually appear between the ages of 30 and 60, but for men, the disease often doesn’t appear until a later age.

What Causes RA?

Normally our immune system protects us from unwanted pathogens such as harmful bacteria and viruses. But in the case of RA, the immune system erroneously targets the body’s joints. This kicks the inflammatory response into gear, causing inflammation within the lining of the affected joint.

Usually, an acute inflammatory response at the site of an injury marks the first step of the healing process. However, in RA, inflammation becomes chronic. This causes the lining of the joints to become thickened, swollen, and painful, preventing the joint from moving smoothly.

Over time, the cartilage that surrounds the ends of the bones in a joint will begin to break down and the space separating the joint bones will become smaller. As a result, the joints become weak and less mobile, eventually becoming deformed.

There’s no treatment or therapy that can reverse joint damage this severe. That’s why early diagnosis and aggressive treatment are so crucial.

Despite great strides in our understanding of RA and its effects, medical researchers still don’t know exactly what causes this disease. Doctors know that an irregular immune response is the underlying issue in RA, but they don’t yet understand what causes this change in the activity of the immune system.

Nonetheless, we do have evidence suggesting that genetics, hormones, and environmental factors may all play a role in RA.

Symptoms

Many people associate immobile, deformed joints with RA, but these symptoms only appear when the disease has progressed over many years. Early detection can help slow disease progression and prevent irreversible joint damage. Therefore, it’s crucial to understand the early signs of RA.

In its early stages, RA symptoms can include:

  • Joint pain, swelling, tenderness, or stiffness lasting for more than six weeks
  • Experiencing symptoms in multiple joints
  • Joint stiffness in the morning lasting for more than 30 minutes
  • Experiencing symptoms in small joints like the wrists, hands, and feet
  • Experiencing symptoms in the same joints on both sides of the body

The inflammation triggered by RA can affect more than just the joints. That’s because RA is a systemic disease, meaning it can affect the entire body. Non-joint related symptoms include:

  • Dryness or irritation in the eyes and mouth
  • Small lumps called rheumatoid nodules under the skin over bony areas
  • Shortness of breath
  • Anemia (a lowered red blood cell count)

Treatments

When treating patients with RA, doctors aim to slow disease progression and prevent permanent joint damage by stopping the abnormal inflammatory response. Treatments should also help patients deal with pain and improve their quality of life.

Therefore, RA treatments fall into two main categories.

  1. Treatments that slow disease progression
  2. Treatments that relieve the symptoms

These two categories aren’t necessarily mutually exclusive. But in general, treatments that slow disease progression include medications that target the inflammatory response. It can also include surgery for those whose RA has already started to cause joint damage. Treatments that relieve the symptoms include prescription and over the counter medications that relieve pain, like ibuprofen.

Those suffering from RA can also take on an active role in their self care and disease management. Strategies like a healthy diet, maintaining a positive outlook, and balancing physical activity with rest can also help keep RA symptoms under control.

Cannabis as Medicine

Alternative therapies and health supplements offer a complementary approach that allows individuals with RA to self manage their disease. In recent years, many RA sufferers have turned to CBD as a supplemental treatment to help ease their symptoms.

The cannabis plant naturally produces the compound CBD. Cannabis is one of the oldest plants cultivated by humans. For thousands of years, humans have grown cannabis for its fibrous stalks, nutritionally-rich seeds, and medicinal properties.

Only in the last century have researchers started to scratch the surface on the science of cannabis. And, unfortunately, research progress has been severely hampered due to the changing legality of the cannabis plant. Let’s take a look at what we currently know about CBD, how it works, and how it can help relieve the symptoms of RA.

CBD: America’s New Favorite Cannabinoid

The biochemistry of the cannabis plant is incredibly diverse. Cannabis produces more than 400 unique compounds. Of those, at least 60 are cannabinoid compounds.

Cannabinoids are a diverse class of chemicals that include CBD as well as tetrahydrocannabinol (THC). THC and CBD are the two most abundant cannabinoids found in cannabis, and until relatively recently, the majority of consumer and research interest focused on THC.

That’s because THC is the main psychoactive compound in cannabis. To put it simply, THC gets you high. Of course, it’s a bit more complicated than that.

The interactions between the complex array of organic compounds in cannabis including terpenes and other cannabinoids create a unique experience for every cannabis strain. This is known as the entourage effect. But without THC, the overall experience wouldn’t be nearly as intoxicating.

On the other hand, CBD has garnered a great deal of attention from researchers, the media, and consumers for just the opposite reason—CBD doesn’t get you high. However, it still holds many of the therapeutic properties of cannabis that have made the plant a valuable medicinal herb for thousands of years.

These attributes make CBD an ideal drug candidate for medical research. So far, new research has demonstrated that CBD has the ability to treat a number of illnesses, diseases, and disorders including:

How Does CBD Work?

So how do cannabinoids like CBD work? It was this very question that led to the discovery of an entirely novel biological network called the endocannabinoid system—“endo” meaning endogenous or coming from within us. This system keeps the body in balance by controlling our appetite, mood, sleep, immune system, and more.

The endocannabinoid system is made up of cannabinoid receptors, endogenous cannabinoids (endocannabinoids), and the enzymes responsible for building and breaking down endocannabinoids.

When ingested, cannabinoids from the cannabis plant—sometimes called phytocannabinoids to distinguish them from our own endocannabinoids—can interact with our endocannabinoid system.

Researchers think that CBD interacts with your endocannabinoid system in two ways. First, it positively regulates the activity of the CB1 and CB2 cannabinoid receptors. And second, CBD slows the breakdown of the endocannabinoid anandamide by regulating endocannabinoid enzymes, thereby increasing anandamide levels in the body.

This means that CBD works by interacting with your endocannabinoid system and boosting its signal. In turn, this keeps your body’s systems in check and in balance.

Can CBD Help Ease Arthritis Pain?

Chronic, unregulated inflammation is the underlying cause of RA progression and pain. Interestingly, the endocannabinoid system appears to play a role in regulating inflammation.

As we just discussed, CBD can help boost the activity of the endocannabinoid system. But can CBD help control unwanted inflammation? So far the research points to ‘yes’. Over the years, several studies have emerged showing that cannabis and CBD have the ability to lower inflammation and inflammation-related pain.

This comprehensive literature review appearing in the prestigious journal Nature outlines the anti-inflammatory properties of cannabis. It goes on to show that cannabinoids can decrease inflammation in the nervous system, gastrointestinal tract, and circulatory system.

Another review discusses in detail the ability of CBD in particular to alleviate oxidative stress, a hallmark of inflammation. This ability makes CBD a potentially powerful anti-inflammatory drug for treating inflammation-based diseases.

But what about RA?

This 2000 study demonstrates that CBD can block the progression of arthritis in mice. Arthritic mice treated with CBD showed decreased levels of important molecular markers for joint inflammation and damage. That means CBD’s ability to regulate the immune system and inflammation resulted in a powerful effect against arthritis in mice.

Similarly, another animal study published in 2016 found that CBD reduced arthritis-related inflammation and pain in rats. Arthritic rats treated with CBD showed less joint swelling and thickening of the joint lining, both hallmarks of RA. They also scored lower on tests used by the researchers to gauge pain.

Studies in Humans

More studies in humans are needed—all of the previous research is preclinical meaning the researchers used either animals or cell cultures for their experiments. However, one promising 2006 study showed that Sativex, a prescription medication comprised of equal parts CBD and THC, reduced pain and improved quality of sleep in patients with RA.

RA patients treated with Sativex experienced improvements in pain on movement, pain at rest, and quality of sleep. They also improved their DAS28 score, a measurement of disease activity for RA that takes into account joint swelling and tenderness, overall pain, blood markers for inflammation, medical imaging scans, and questionnaire results.

Even the Arthritis Foundation recognizes CBD as a valuable, supplemental treatment that can help patients manage their RA. And according to a 2019 survey conducted by the Arthritis Foundation, 67% of respondents who reported taking CBD to treat their RA symptoms experienced an improvement in their physical function. 77% and 67% also reported improvements in anxiety and depression symptoms respectively.

CBD: Frequently Asked Questions

Maybe you’re ready to give CBD a try, but more likely than not, you still have quite a few questions. Here are the answers to some of the most common questions that people have before trying CBD for the first time.

Is CBD legal?

Legality is probably the biggest concern when it comes to CBD. However, CBD is legal to buy and consume in the United States.

Nearly all of the CBD that you find for sale online and in stores is made from hemp. Hemp is a special variety of cannabis that is CBD-rich, but contains almost no THC, the intoxicating cannabis compound.

Hemp doesn’t get you high and also has some other incredibly useful industrial applications. But for decades, hemp has been legally lumped in with illicit, high-THC cannabis varieties.

However, in 2014, Congress passed a new Farm Bill that removed legal restrictions on industrial hemp (any cannabis strain containing less than 0.3% THC). Under the new bill, state agricultural departments could establish their own pilot programs and license farms to grow hemp.

The 2018 Farm Bill took another step forward, removing hemp and hemp-derived products like CBD from their Schedule I status under the Controlled Substances Act.

Is CBD safe?

According to an annual report published by the World Health Organization, CBD has a good safety profile. And, despite increasing use, there are no public health concerns related to the use of pure CBD. The report also notes that CBD has a very low risk for dependence and abuse.

Are there side effects?

Although CBD is generally safe, it does have some minor side effects. Summarizing all of the clinical trials on CBD in the form of Epidiolex, the FDA notes that CBD most commonly causes drowsiness, decreased appetite, and diarrhea.

CBD also has the potential to interact with other medications. This may cause additional negative side effects.

Should I talk to my doctor?

YES! Like any health supplement, you should talk to your doctor about adding CBD to your routine. Talking to your doctor can help you avoid any risk associated with possible drug interactions.

Where do I buy CBD?

CBD products are available online and in stores across the country. Just make sure to choose a reputable brand that offers transparency when it comes to their hemp sourcing, manufacturing process, quality testing, and ingredient formulations.

The best CBD companies use hemp grown in the United States and will submit their products to rigorous quality testing that verifies CBD potency and tests for common contaminants like pesticides and heavy metals.

How much CBD should I take?

When it comes to dosing CBD, there isn’t a consensus and the effects of CBD can vary from person to person. The best course of action is to start low and go slow.

Begin with a relatively low dose (5 or 10 mg of CBD) and wait to see how you feel. You should start to feel the effects within 30 minutes. It’s possible to build up a tolerance to CBD so it’s better to start on the lower end.

If you don’t feel any effect, slowly increase the dose by increments of 5 or 10 mg until you feel the desired results. You may want to split up your CBD dose by taking it once in the morning and once in the evening so the effects will be evenly spread throughout the day.

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