The Disease

Arthritis is joint inflammation characterized by swelling, pain, stiffness and decreased range of motion.  In almost all arthridites, the cartilage in the joint ends up being damaged and ultimately destroyed giving rise to the symptoms associated with the disease.  There are over 100 different known causes of arthritis but most research with CBD has been done in 2 of them: osteoarthritis (OA) and rheumatoid arthritis (RA).  Osteoarthritis, also known as degenerative arthritis, is the most common arthridites and associated with aging, injury, and other issues, while rheumatoid arthritis is considered an inflammatory and/or autoimmune disease. 

Research

Although the causes and the cellular changes inside the joints are different in these two diseases, ultimately, in both diseases, the cartilage self-destructs by releasing enzymes (proteases) that degrade the building blocks of cartilage (collagens and proteoglycans).1  Collagen is a matrix of collagens, proteoglycans, and other proteins with some cells living in the matrix that are called chondrocytes.  The chondrocytes control the production of new matrix the cartilage is gradually worn away from movement, etc. and, when the joint is healthy, new matrix is produced at a rate to perfectly compensate for that which is lost.2  This homeostasis is interrupted when the matrix is lost faster than it can be replaced (excessive wear), the chondrocytes slow down their production of matrix secondary to oxidative stress, or the environment becomes hostile (inflammation or autoimmune disease).  In all of these cases, the end stage is the production of enzymes called metalloproteinases (MMPs) which destroy the proteins in the collagen matrix.1  Once the matrix starts being destroyed, it enters a self-sustaining cycle of increasing inflammation and oxidative stress that results in the collagen ultimately destroying itself.

Interesting, the joints of both humans and animals have functional endocannabinoid systems (ECS).  The ECS help maintain the homeostasis of the joint by: 1) maintaining healthy chondrocytes, 2) influencing the production of collagen matrix, and 3) maintaining the health of the other tissues in the joint including the bone, synovium (membrane that lines the joint) and the synovial fluid (the fluid contained in the joint by the synovium).3,4  CBD, through its anti-inflammatory and anti-oxidant effects that work, not like most anti-inflammatory drugs, but by changing the cell signaling events that underlie the self-sustaining cycle of inflammation and oxidative stress has great promise for treating arthritis.  In addition, the anti-nociceptic and anti-inflammatory pain effects of CBD has potential to block the pain associated with arthritis.5  Therefore, not only does CBD has the theoretical potential to alleviate the symptoms of these arthridites, it has the potential to reverse the disease itself if the cartilage is not to severely damaged.6,7  It seems that the public is aware of these potentials of CBD, such that, chronic paint of arthritis is the most common reason for people to take CBD.8,9  In a recent review, the authors concluded that because of the preclinical and human data that do exist, the use of cannabis should be taken seriously as a potential treatment of joint pain.9

Bottom Line

CBD has great potential to alleviate the pain and symptoms of arthritis, in particular osteoarthritis and autoimmune arthritis.  However, at this time the FDA has not approved CBD for the treatment of any type of arthritis.

(Note: See Arthritis: Rheumatoid Arthritis and/or Arthritis: Osteoarthritis for more information on these individual conditions.)

References

  1. Goldring M, Marcu K. Cartilage homeostasis in health and rheumatic diseases.  Arthritis Res Therapy 2009;11:224.
  2. Bolduc JA, etal. Reactive Oxygen Species, Aging and Articular Cartilage Homeostasis. Free Radic Biol Med. 2018; Aug 31. pii: S0891-5849(18)31500-4.
  3. Schuelert N, McDougall JJ. Cannabinoid-mediated antinociception is enhanced in rat osteoarthritis knees. Arthritis Rheum 2008;58:145–53.
  4. Richardson D, etal. Characterisation of the cannabinoid receptor system in synovial tissue and fluid in patients with osteoarthritis and rheumatoid arthritis. Arthritis Res Ther 2008;10:R43.
  5. Booz G. Cannabidiol as an emergent therapeutic strategy for lessening the impact of inflammation on oxidative stress.  Free Radic Biol Med 2011;5(5):1054-61.
  6. Laragione T, etal. The cation channel TRPV2 is a new suppressor of arthritis severity, joint damage and synovial fibroblast invasion.  Clin Immunol 2015;158(2):183-92.
  7. Reed KN, etal. The role of mitochondrial reactive oxygen species in cartilage matrix destruction.  Mol Cell Biochem. 2014;397(1-2): 195-201.
  8. Corroon J, Phillips J. A cross-sectional study of cannabidiol users.  Cannabis and Canna Res 2018;3(1):152-161.
  9. Miller RJ and Miller RE. Is cannabis an effective treatment for joint pain? Clin Exp Rheumatol.2017 Sep-Oct;35 Suppl 107(5):59-67.

 

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