Arthritis is a common condition that affects the joints, causing pain and inflammation. It is thought that over 10 million people are affected by arthritis or other, similar conditions in the UK alone. Other estimates suggest that up to 23% of the adult population are suffering from arthritis. Such conditions can affect people of all ages, including children; however, they most commonly develop in middle-age and beyond. The most common types of arthritis are osteoarthritis and rheumatoid arthritis. Other forms of arthritis include psoriatic arthritis, lupus arthritis, and lyme arthritis – all of which are types of autoimmune arthritis.
Patients with arthritis are subject to chronic pain, joint degeneration, and articular neuropathy – all of which may result in reduced activity and quality of life. Furthermore, there are currently few viable long-term treatment options available for these symptoms. The high prevalence of arthritis and other conditions that affect the joints and the consequential effect on patient quality of life and cost to society makes effective treatment options an important consideration for medical research.
Current Treatment Options for Arthritis
There is no cure for arthritis, but there are a number of management options that may be considered for symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly the first line of treatment for pain, despite their gradual decline in efficacy and links to adverse events, including bleeding, peptic ulcer disease, cardiovascular events, and acute kidney injury. Other treatment options for pain symptoms include opioid-based painkillers.
The effective management of joint pain associated with arthritis remains difficult, with many patients requiring surgical solutions. A total or partial joint arthroplasty may be considered in the right patients once non-operative modalities have failed. Nonetheless, there remains a significant need for additional effective treatment options to aid pain management in arthritis and other related conditions.
Arthritis and Medical Cannabis/CBD
Two cannabinoids – cannabidiol (CBD) and tetrahydrocannabinol (THC) – have been increasingly assessed for to identify if they have any role in alleviating pain of any kind. In order to fully evaluate the effects of CBD further, the authors of a recent study undertook a survey-based study of those with arthritis.
Design and Methods of the Study
The aim of the study was to answer three questions: (I) Do patients with arthritis report improving or worsening symptoms with CBD use? (II) Was CBD use associated with decreases in other pharmacologic treatments for patients with arthritis? (III) Were there any differences in reported symptoms based on the type of arthritis?
In order to answer these questions, the researchers designed a survey to evaluate participants’ perceived efficacy of CBD for their arthritic symptoms. The survey gathered demographic information in addition to data on characteristics of CBD use and previous treatment modalities. Participants were a self-selected sample who accessed the online survey between May 5, 2020, and November 5, 2020. The survey was distributed through various means, including online personal and health system social media accounts as well as groups for the Arthritis Foundation® and Savvy Cooperative®.
The efficacy of CBD use for pain management and arthritis symptoms was assessed by several different outcome variables. For example, improvements in pain intensity were evaluated using a 5-point Likert scoring system, ranging from “much worse” to “much better”. The Patient Global Impression of Change (PGIC) scale was also used to assess the perceived effect of CBD use on sleep quality and physical function.
Participants were also asked to rate their pain on a 0-10 Numerical Rating Scale (NRS) before and after taking CBD. Pain improvement with a 2.0-point reduction or 30% improvement in pain from baseline was considered as a clinically important change. Last of all, participants were asked questions about reductions and cessations of medications related to their CBD use.
Results of the Study
A total of 428 survey responses were included in the formal analysis. Participants were categorised based on the type of arthritis they had: osteoarthritis, rheumatoid arthritis, and other autoimmune arthritis (included psoriatic arthritis, lupus arthritis, etc.).
Most participants (70%) reported trying CBD for symptomatic relief of arthritis. Of the participants who had not tried CBD, 49.6% reported that they required more information or evidence, 24% were unsure of side effects, 15% had concerns over the legality and drug testing, and 6% said it was too expensive. Patients that did use CBD tended to be younger than those that did not. Participants reported prior treatment with anti-inflammatories (n=392, 91.4%), acetaminophen (N=283, 66.0%), physical therapy (N=274, 60.7%), intra-articular steroid injection (N=197, 45.9%), and opioids (N=181, 42.19%).
For participants who used CBD – over a third (37.9%) reported their average daily pain was “much better”, and 45.1% reported their pain was “a little better”. For physical function, 28.7% reported feeling “much better,” and 37.4% reported feeling “a little better.” For sleep quality, 37.6% reported feeling “much better,” and 28.5% reported “a little better.” In contrast, fewer than 3% of participants reported that their pain, sleep or physical or functioning had worsened with the use of CBD.
A significant proportion of participants (41%) reported at least one side effect. The most common side effects were dry mouth (20%), drowsiness (17%), increased or decreased appetite (9%), dry eyes (8.6%), impaired concentration (5.4%), dizziness (4%), headache (4%), and digestive complaints (3.5%). Of the reported side effects, 84% were considered mild, 14% moderate, and 2% severe.
Finally, over half (60.5%) of participants who had used CBD reported reducing or discontinuing the use of other medications. Of those patients that reduced or discontinued medications after starting CBD, 31.1% reduced anti-inflammatory medications and 17.8% discontinued them altogether.
The results of this study demonstrate that there was a perceived change in symptom profile after administering CBD. However, the authors note the exploratory nature of study and stress the need for further research in this area. In particular, the researchers suggest that future research should “focus on exploring the benefits of CBD use in this patient population with well-controlled clinical trials.”