CBD For Rheumatoid Arthritis

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.

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.

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:

• Nausea
• Fatigue
• Irritability
• Diarrhea
• Dry mouth
• Lightheadedness
• Sleepiness
• Low blood pressure
• Appetite changes

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.

Warnings

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. 

Interactions

Studies have found moderate interactions between CBD and medications commonly prescribed for treating RA.

Interactions can occur with these medications:

• Corticosteroids
• Tofacitinib
• Naproxen
• Celecoxib
• Tramadol
• Some antidepressants, including amitriptyline, citalopram, fluoxetine, mirtazapine, paroxetine, and sertraline
• Some medications used for treating fibromyalgia, including gabapentin and pregabalin

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
• Corticosteroids
• 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.