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.
CBD Dosage: What’s the Right Dose of CBD for Pain Relief?
Take a look at the label on any over-the-counter pain reliever and you can easily figure out how much you’re supposed to take for your symptoms. Finding the right dose of cannabidiol (CBD) for pain relief, however, isn’t that simple.
Enthusiasts rave about CBD’s potential to ease pain, reduce inflammation, relieve anxiety and promote sleep. However, there’s no conclusive research about just how much CBD a person needs to take in order to experience benefits.
There are very few human studies on CBD, and those that have been done include doses that are all over the map: In some studies, patients used 5 mg of CBD; in others, they took as much as 600 mg. To further add to the confusion, CBD comes in a number of forms — oils and tinctures, creams and lotions, pills, vaping, and edibles — and each one has differences in terms of bioavailability (the percent of active ingredient that gets into your bloodstream).
“There are no standard doses for patients,” says Rachna Patel, DO, a physician who does consultations about medical marijuana and CBD and sells her own line of CBD products. “Ultimately, it’s trial and error, but you have to go about it in a methodical way.”
Here are some tips to guide you on how to find the right CBD dosage for your pain relief and other symptoms.
1. Work with an expert
Many factors, such as your body mass index (BMI), specific health condition(s) you have, medications you take, your health history, and the form of CBD you plan to use can influence how much CBD you may need to treat your symptoms. Although CBD is different than medical marijuana — which contains CBD as well as THC, an intoxicating ingredient — a doctor who’s well-versed in cannabis (marijuana) is probably the best person to help you help you sort it out.
“I wouldn’t recommend starting CBD without the supervision of a physician,” says Dr. Patel, author of The CBD Solution. “Many times people purchase a CBD product, try a dose that that doesn’t work for them, switch products and spin their wheels. Or, worse, they develop side effects.”
Ask your rheumatologist or primary care provider to recommend an expert, or find an expert near you by searching the directory of members of the Society of Cannabis Clinicians or the database maintained by your state’s medical marijuana program (if it has one).
2. Do some math
Let’s say you and your doctor settle on a dose of 30 mg of CBD per day. Now what? The answer depends on which form of CBD you take.
Figuring out how much CBD is in capsules or gummies is simple — just read the supplement facts section on the label. (If it says 10 mg of CBD per capsule, you’d take three capsules to get your 30 mg of CBD a day.)
Oils and tinctures can be trickier because the packaging often states the amount of CBD in the entire bottle, not in a dropper. This calculator can help you figure out how many drops you need based on the strength of the product.
When it comes to CBD in topical form (creams, lotions, and salves), you’ll probably see the total amount of CBD in the container listed on the label. You’ll then have to divide that total by the number of millimeters in the package to determine how much is in each milliliter. For example, if you have a 50 ml jar of salve that contains 200 mg of CBD, there’s 4 mg per ml. You should then use a metric measuring spoon to scoop out 7.5 ml to get a 30 mg dose of CBD.
3. Expect some trial and error
No two patients respond to CBD in the same way. You and your doctor will probably need to adjust the dose either up or down until you hit the right balance of benefits without side effects. “A lot of it depends on your biochemistry and the way your liver breaks down these chemicals. There’s a wide variety of factors that come into play,” says Dr. Patel.
It can take a little while to get it right, so be patient. Many people do not see a difference in symptoms after one or two doses of CBD. It can take up to eight weeks of regular use to feel an impact, says Bridget Seritt, co-founder of the Canna-Patient Resource Connection, a Colorado-based organization that is working to protect patient rights and end stigma against those who choose cannabis as medicine.
4. If you have side effects, stop or lower the dose
CBD won’t get you high the way that cannabis with THC can, but it may still cause side effects. “The most common side effects are fatigue and lethargy, and in rare cases diarrhea,” says Dr. Patel, who notes that CBD that’s taken topically less commonly causes side effects. Topical CBD is best used to address pain in a single joint, rather than widespread pain, she adds.
No matter which form of CBD you use, pay attention to how you feel. If you notice any negative side effects, stop or lower the dose and consult your doctor.