About 54 million adults and 300,000 children have been diagnosed with some form of arthritis in the US, and this number is expected to grow. Globally, we are looking at closer to 350 million people with arthritis. Quality of life for arthritic patients is fraught with pain, stiffness, limited mobility and decreased movement within the joints. Current treatments often have undesirable side-effects which make CBD more attractive as an alternative treatment for the patient with arthritis pain and inflammation.
What is Arthritis?
Arthritis is inflammation of a joint or multiple joints. While arthritis means joint inflammation, the term describes any one of over 200 similar illnesses of inflammation that affects the joints, cartilage, tissues around the joints and connective tissues.
CBD is known to reduce inflammation and the pain that comes with inflammation. CBD could theoretically be useful for all forms of arthritis.
Systemic arthritis extends its influence beyond the joints to the eyes, tissues, organs and other parts of the body. This is most common in rheumatoid arthritis, which is an autoimmune condition. CBD could be useful in systemic arthritis since it interacts with the endocannabinoid system and receptors for cannabinoids exist throughout the body and brain.
What Are the Most Common Types of Arthritis?
The two most common types of arthritis are osteoarthritis and rheumatoid arthritis with osteoarthritis, also known as degenerative joint disease, being the most common form. Other forms that arthritis can take include bursitis, certain types of back pain and Sjogren’s Syndrome.
In this type of arthritis, the cartilage gradually wears away leaving bone to rub on bone, which in turn creates inflammation and pain. Cartilage is the slippery, cushioning material on the end of bones. Athletes are at high risk for this type of arthritis due to having anterior cruciate ligament or ACL tears. Other risk factors include age, excess weight, and genetic history.
Osteoarthritis can be avoided by staying active, maintaining a healthy weight, preventing injuries and avoiding repetitive movements.
Rheumatoid arthritis is a form of autoimmune disorder where the immune system attacks the lining of the joint capsule causing swelling and inflammation. This type of destruction can completely decimate the cartilage and bone in the joint capsule leading to further inflammation and pain.
Current Arthritis Treatments
Current therapies for arthritis include nonsteroidal anti-inflammatories (NSAIDs), cortisone, narcotics, counterirritants (preparations that interfere with pain signals such as menthol), disease modifiers and biologic response modifiers. Adverse side-effects exist for all these therapies except for counterirritants, which is a category CBD topicals would fall into. For example, NSAIDS may lead to acute kidney injury and gastrointestinal bleeding. Immunosuppression is a common side effect of cortisone.
Can CBD Help with The Pain of Arthritis?
CBD and arthritis pain
Those who use CBD for arthritis are increasing and according to a recent conference survey, over 60% reported using CBD. This is despite a lack of clinical evidence for its therapeutic use in this condition. Research on animals is promising, however, on potential applications of CBD to the alleviation of pain associated with arthritis in humans.
CBD both silences the CB1 receptor while activating the CB2 receptor that is widespread in the immune system. By doing this, it affects the inflammation in arthritis that is causing pain and may even have an effect on the pain signaling itself.
What do the Studies Say About CBD and Arthritis?
Evidence shows us that the endocannabinoid system (ECS) functions in humans and animals both in the joint and joint capsule. We also know that CB1 and CB2 receptors for cannabinoids are widespread throughout the joints and blood supply to the joint. . If CBD has an effect on the joints and microvasculature then it theoretically may be used to prevent arthritis pain and disability in humans.
Transdermal application of CBD for arthritis pain
One animal study utilized a transdermal delivery mechanism for CBD in rats that had arthritis induced. The treatment inflammation and hypersensitivity to pain. A linear dose response was noted for lower doses of .6, 3.1 and 6.2 mg/day that was eliminated at 62.3 mg per day. Lower doses tended to be as effective as higher doses in this model.
Local application of CBD for arthritis pain
According to the results of this study, local application of a 10% CBD gel on the skin directly laying over an inflamed joint in patients would potentially increase CBD concentrations and promote effectiveness without systemic effects. Not only would the treatment reduce inflammation but it would serve as a protectant for the nerves as well.
In another study on the same animal model, a significantly higher oral dose was required to achieve the same effects, 5 mg/kg. Curiously, a bell-shaped dose curve was noted with both the lower and higher amounts showing less effect than the dose in the middle.
Can CBD Studies on Animal Dosages Relate to Human Dosages?
While we cannot extrapolate dosages from animal models to humans, we can take note of trends in dosages and how CBD functions biochemically.
Currently, with the knowledge that cannabinoid receptors are located throughout the body for both animals and humans and the endocannabinoid system is highly involved in the regulation of inflammation and pain, it is no wonder we are excited about the potential therapeutic uses of CBD for arthritis. One main roadblock to an official use of cbd oil for arthritis is the lack of evidence-based dosage guidelines which will only come with further clinical trials that show the benefit of CBD for arthritis in humans and dosage guidelines to follow.
CBD Mechanism of Action and Arthritis
4 CBD mechanisms in reducing arthritis pain and inflammation
The primary mechanism of action for CBD in reducing pain is the reduction of the inflammation causing the pain. There is limited evidence that CBD blocks the pain signaling response.
We know that CBD induces apoptosis (programmed cell death), inhibits cell proliferation, suppresses cytokine production and induces the T-regulatory cell pathway. These are all hallmark metabolic pathways involved in inflammation.
CBD’s actions on receptors and metabolites
In addition,CBD is a CB2 receptor agonist, prevents the degradation of the body’s own endocannabinoid, anandamide, and releases arachidonic acid metabolite by products.Arachidonic acids causes inflammatory mediators to be released thus aggravating the arthritic process and increasing pain.
Can CBD Prevent Arthritis?
Anandamide, one of the body’s own endocannabinoids, helps fight pain. CBD interferes with the enzymatic degradation of this endocannabinoid thus indirectly alleviating pain by increasing the availability of this pain fighting molecule.
CBD also acts via the entourage effect to create an anti-inflammatory response in the body utilizing the synergistic actions of other natural cannabinoids, terpenes and flavonoids, all of which have anti-inflammatory actions of their own.
CBD Products for Arthritis
Using CBD topical lotion for arthritis
Topical ointments and creams for arthritis are frequently combined with synergistic essential oils that have anti-inflammatory or numbing pain relieving effects such as menthol, camphor, or tea tree oil. These oils need to be diluted in a carrier oil so as not to burn the skin, so they are frequently combined with a moisturizing oil such as jojoba or olive oil. The combined effects of CBD and the essential oil produces an additive effect on inflammation reduction and pain relief.
Oral use of CBD oil for arthritis
Oils exist in a concentrated form and can be consumed orally or inhaled by vaping. Dosages for oils that are inhaled are frequently lower than those needed to achieve the same effects when taken orally. Oils that are taken under the tongue need to be held for 60 seconds for optimum absorption.
Whole Hemp vs. Isolated CBD
Whole hemp contains other molecules called terpenes and flavonoids that have a synergistic effect on CBD increasing therapeutic outcomes by complementary mechanisms or increasing CBD’s bioavailability. Many terpenes have anti-inflammatory, pain reducing effects of their own making whole hemp a more viable choice due to what we call the entourage effect from the combined synergistic effect of all molecules in the hemp plant.
Considerations Before Taking CBD
The Food and Drug Administration (FDA) does not recognize or approve of CBD as a treatment for arthritis (yet). It is only approved to treat two forms of epilepsy and comes in a prescription form called Epidiolex.
FDA wants more clinical evidence before approving CBD for use in other conditions. Such clinical evidence is lacking primarily due to the previous legal status of CBD. In 2018 the passing of the Farm Bill legalizing hemp for public use was enacted. Hemp is less than 0.3%
THC but contains other cannabinoids, including CBD. CBD is not psychoactive like THC nor does it have addictive properties. Now that the law is on the side of CBD, more clinical studies are expected in the very near future.
CBD is a safe alternative to the drugs we currently have in use to treat arthritis. While animal studies are promising, more human clinical trials are needed before treatment recommendations can be evidence-based.