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.
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Scott J. Zashin, MD, specializes in the treatment of rheumatologic and musculoskeletal conditions using both traditional and alternative therapies.
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 healthcare provider 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 healthcare provider.
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 healthcare provider, who will oversee its effectiveness and side effects. There have been reports of mild side effects of CBD.
The most common side effects include:
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 healthcare provider. Additionally, CBD shouldn’t be a replacement for other therapies you are using.
Pregnant people and children should consult a healthcare provider 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:
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 healthcare provider(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 healthcare provider 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 healthcare provider.
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 healthcare provider 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 healthcare provider 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.
Does CBD Oil Help With RA?
People with rheumatoid arthritis and other pain conditions are trying cannabinoids to alleviate their symptoms. Here’s what you need to know.
There was a time in Ron Lev’s life when the pain from his rheumatoid arthritis (RA) was so bad that he felt like nothing could help him.
“You just sit still because it’s too painful to stand,” says Lev, 44. “Everything you can imagine doing is painful. Even eating is painful. Driving a car, opening a door, turning the ignition.”
After decades of treating his RA with biologic drugs and steroids, Lev was on the verge of accepting the pain as his “new normal.” However, he’d heard of other people with the condition using cannabinoids (CBD) to alleviate their pain and, four years ago, he decided to give it a try, too.
“At that time, I’d been on steroids for 23 years,” he says. Some of the long-term side effects he’d experienced from the medication included thinned skin, bloating, and weight gain, among others. “I tried unsuccessfully to wean off the steroids, but the pain was so bad… that I just kept using them.”
Within months of starting on cannabinoids, with guidance and direction from his rheumatologist, Lev not only weaned himself off the steroids, he was also able to spread out his biologic infusions from every couple of months to every 6 months. Now, he only gets infusions once a year.
After seeing the tremendous pain relief CBD offered him personally, Lev started his own CBD company, Reclaim Labs, in 2018.
Stories like Lev’s are becoming more and more common among people with RA and other autoimmune disorders. According to a 2019 poll from the Arthritis Foundation, 29 percent of people with arthritis report currently using CBD — mainly in liquid or topical form — while nearly 80 percent were either using CBD, had used it in the past, or were thinking about using it.
There’s also growing scientific evidence, including a study published in September 2020 in the journal Cell Disease & Death, that cannabinoids can alleviate pain from RA and act as an effective anti-inflammatory agent, with few, if any, side effects — unlike anti-inflammatory drugs such as steroids or biologics options.
“We’re seeing more organized and well-done research on the benefits of cannabinoids and CBD when treating RA,” explains Anca Askanase, MD, a rheumatologist and associate professor of medicine and director of rheumatology clinical trials at Columbia University Medical Center in New York City. “As a culture we’ve embraced both medicinal and recreational use of marijuana, and we’re seeing that it does help alleviate pain, especially with RA patients.”
Research on CBD in RA Needed
Positive news aside, Dr. Askanase cautions that more studies doesn’t necessarily mean enough studies.
“We’re going about things backwards — it’s been approved before we have all the research there to support it,” she says. “My biggest concern is that we need to understand and use cannabinoids in a more organized and mindful way as opposed to just saying, ‘It’s legal, it sounds like it works, just take some.’”
One reason for the hesitation on the part of Askanase and her fellow rheumatologists is that while cannabinoids may significantly reduce pain and inflammation, they can also trigger other side effects when smoked. For example, people who have RA can have a greater risk of developing lung and heart issues, which can be exacerbated by smoking marijuana, according to the Centers for Disease Control and Prevention.
Another concern, says Askanase, is the potential addictive nature of the drug. “We’ve learned that most of the things that act on the brain like cannabinoids do have some addictive potential,” she explains. “This is something that needs to be further researched.”
The Truth About CBD Oil and RA
Still, there’s no denying that despite the lack of research, people with RA report that CBD has significantly lessened their pain.
A survey published in November 2019 in the Journal of Psychoactive Drugs found that, of the respondents taking legalized cannabis for pain relief, 80 percent described it as “very or extremely helpful.” Among respondents taking over-the-counter pain medications, 82 percent reported reducing or stopping use of those medications. Among respondents taking opioid analgesics, 88 percent reported reducing or stopping use of those medications.
“I tried for years to stop taking steroids and it’s incredibly difficult to do,” explains Lev. “CBD is the only thing that has helped get me off steroids and relieve my pain.”
Additionally, there’s research that shows cannabis has a powerful anti-inflammatory effect, which can help address the inflammation behind RA. According to a review published in May 2019 by the journal Current Opinion in Rheumatology, researchers have found that “cannabinoids show anti-inflammatory effects by activating cannabinoid type 2 receptors, which decrease cytokine production” (cytokines are proteins known to be involved in inflammation).
The authors concluded that cannabis may be a suitable option for treating RA.
While Askanase is among a growing number of rheumatologists who are interested in seeing more research on CBD in RA, she also cautions that it shouldn’t be used as a stand-alone treatment.
“We need to very clearly make an effort to say that cannabinoids are supplementary interventions but should not replace the traditional disease-modifying therapies we currently have available,” she explains. If you’re considering using CBD as a complementary treatment option, she says, you should seek out medical marijuana dispensaries, which have some medical supervision and control over the products and the amount being used.