Rheumatoid arthritis is the most common form of chronic inflammatory arthritis affecting about 1% of the world’s population and being 3 times more common in men than in women. It is an autoimmune disease, in which the immune system attacks the synovial membrane causing it to swell and become hyperplastic (having more cells). This causes the symptoms of pain, swelling, redness, and stiffness of the joints. The smaller joints tend to be most affected, especially in the hands and wrists and the disease is bilateral, affecting both sides of the body. Most people think of RA as involving only the joints, however, RA is a systemic disease and affects the homeostasis of the whole body. Systemic inflammation and autoimmunity precede the development of the arthritis in RA, sometimes appearing years prior to the onset of symptoms. RA is affected by genetics (certain HLA gene types are 5 times more likely to develop RA than those without those genes), infections (RA will often develop after an infection in people susceptible to the disease), immune system (Rheumatoid factor, an auto-antibody, is found in 80% of RA patients and people with a different autoimmune disease are 5 times more likely to develop RA), hormones (women 3 times more likely to develop RA than men), stress (stress is higher in RA patients), and microbiome (the gut bacteria are abnormal in patients with RA and tend to normalize with therapy).1,2 In addition, RA patients have multiple comorbidities including: depression, diabetes, heart disease, obesity, insomnia, eye disorders, hearing loss, kidney disease, skin disease, and mouth conditions. The loss of homeostasis in so many bodily systems and the pain associated with RA makes CBD attractive as a possible therapy for RA because if its ability to restore homeostasis and its pain relief.
In RA, inflammation occurs and the synovium becomes thicker and full of cells and is called pannus. Pannus has unique characteristics, and, like a cancer, it can invade the cartilage and bone. Over time, this invasion causes the deformation of the joints commonly seen in RA. The hyperplastic cells in the synovium are called fibroblast-like synoviocytes (FLS) which cause the formation of the synovial pannus and the cancer-like invasiveness seen in the disease.3 The number of vanilloid receptors (TRPV2) on the synoviocytes in RA in increased, and is very high when invasion of the joint by the pannus is present.3 When an agonist (a compound that will stimulate a receptor) binds to TRPV2, the invasiveness of FLS decreases, inflammatory cell inflammation decreases, joint damage is reversed, and the amount of pain decreases.3 Because CBD is a TRPV2 agonist, it is seen to be a prime candidate for treating RA.4 In addition, the inflammation within the joint causes the chondrocytes to release MMPs (enzymes that break down the proteins in collagen) which cause destruction of the collagen matrix and ultimately the collagen itself. When inflammation decreases the MMP’s decrease and the joint improves.5
Although RA is a systemic disease, most modern therapy is directed to relieving the pain and stiffness in the joints. On the systemic inflammation and autoimmunity, CBD has the potential to reduce inflammation and its effect on the immune system is well known.6 Therefore, CBD has the potential to improve the pain (see Pain: inflammatory pain), the joint abnormalities, and the systemic features of RA. In a study of RA patients, Savitex (a drug containing both THC and CBD) was found to significantly improve overall pain, pain on movement, pain at rest, quality of sleep, and disease activity.7
The basic science and limited human studies along with numerous anecdotal reports of patients with RA suggest the CBD can be very helpful in treating the symptoms and reversing the damage of RA. However, at this time the FDA has not approved CBD for the treatment of RA.
- Arthritis Foundation, Rheumatoid Arthritis, Viewed 9/7/2018, 1355 Peachtree St NE, Suite 600
Atlanta,GA 30309. < https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/>.
- Zhang X, etal. The oral and gut mmicrobiomes are perturbed in rheumatoid arthritis and partl normalized after treatment. Nature Medicine. 2015;21:895-905.
- 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.
- Qin N, etal TRPV2 is activated by cannabidiol and mediates CGRP release in cultured rat dorsal root ganglion neurons. J Neurosci 2008;28(24):6231-8.
- Reed KN, etal. The role of mitochondrial reactive oxygen species in cartilage matrix destruction. Mol Cell Biochem. 2014;397(1-2): 195-201.
- Rieder S, etal. Cannabinoid-induced apoptosis in immune cells as a pathway to immunosuppression. Immunobiology 2010;215(8):598-605.
- Blake DR, etal. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain cause by rheumatoid arthritis. Rheumatology (Oxford). 2006;45(1):50-2.