Cannabis and Arthritis
More than 31 million Americans suffer from arthritis. There are two common types of arthritis, rheumatoid arthritis and osteoarthritis, but both affect the joints, causing pain and swelling, and limiting movement. Rheumatoid arthritis is caused by a malfunction of the immune system. Instead of fighting off intruders such as bacteria or viruses, the body attacks the synovial membranes, which facilitate the movement of joints, eventually destroying cartilage and eroding bones. Rheumatoid arthritis is most common among the aged, whose immune systems are no longer as robust or efficient. Osteoarthritis, or arthritis of the bones, is also found primarily among the elderly, whose cartilage has been worn away through use. Arthritis may also manifest as chronic inflammation of the joints as the result of injuries.
Recent research is accumulating evidence that cannabis therapies are effective for arthritis and the other rheumatic and degenerative hip, joint and connective tissue disorders. Since these are frequently extremely painful conditions, the ability of cannabis to combat chronic pain makes it useful for that aspect, both on its own and as an adjunct therapy that enhances the efficacy of opiod painkillers. The use of cannabis as a treatment for musclo-skeletal pain in western medicine dates to the 1700s.[12-13]
But cannabis has also been shown to have powerful immune-modulation and anti-inflammatory properties,[14-17] indicating it may treat chronic inflammatory diseases directly. In fact one of the earliest records of medical use of cannabis—a Chinese text dating from ca. 2000 BC—notes that cannabis is effective in treating rheumatism, suggesting that ancient societies long ago recognized its anti-inflammatory and analgesic properties.
Modern research on cannabidiol (CBD)—one of the non-psychoactive components of cannabis—has found that it suppresses the immune response in mice and rats that is responsible for a disease resembling arthritis, protecting them from severe damage to their joints, and markedly improving their condition.[19-20]
Human studies have shown cannabis to be an effective treatment for rheumatoid arthritis, and it is one of the recognized conditions for which many states allow legal medical use. Cannabis has a demonstrated ability to improve mobility and reduce morning stiffness and inflammation. Research has also shown that patients are able to reduce their usage of potentially harmful Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) when using cannabis as an adjunct therapy.[21-22]
Medical researchers investigating Cannabidiol at Hebrew University in Jerusalem discovered an acid with potent anti-inflammatory action comparable to the drug indomethacin, but without the considerable gastrointestinal side effects associated with that drug.
In addition, when the body metabolizes tetrahydrocannabinol (THC, one of the primary components of cannabis) it produces a number of related chemicals. At least one of these metabolites has anti-inflammatory and pain-relieving effects. By modifying this metabolite, researchers at the University of Massachusetts Medical Center have produced a synthetic carboxylic acid known as CT-3 (also called DMH-11C, chemical name dimethylheptyl-THC-11 oic acid), which is more powerful than the natural metabolite and can be given in smaller doses. Animal tests found CT-3 effective against both chronic and acute inflammation; it also prevented destruction of joint tissue from chronic inflammation. The long safety record of marijuana (no one has ever died of an overdose) and the discovery that a metabolite with the desired anti-inflammatory effect is produced in the body when marijuana is used, strongly suggest that safe and effective anti-inflammatory drugs may be developed from cannabinoids.
In addition, CT3 has demonstrated analgesic effects in animals. In some cases, the dose-dependent effect of THC was equivalent to morphine, but with a much greater duration of action.[25-26] In contrast to the NSAIDs commonly prescribed arthritis sufferers, CT3 did not cause ulcers at therapeutically relevant doses. Moreover, it does not depress respiration, produce dependence, induce body weight loss or cause mutations. Studies on its mechanism of action are currently underway, and cytokine synthesis is one of the pathways being investigated.
Cannabis may also help combat rheumatoid arthritis by way of its established immune-modulation properties. Rheumatoid arthritis is characterized by dysregulation of the immune system in response to an initial infection or trauma. Over-activity of the immune system’s B-cells causes antibodies to attack and destroy the synovial tissues located in the joint.
The immuno-modulatory properties of a group of fats found in cannabis, known as sterols and sterolins, have been used as natural alternatives to conventional rheumatoid arthritis treatments, which typically employ highly toxic drugs to either suppress the entire immune response of the body or to palliate pain and the inflammatory process without correcting the underlying immune dysfunction.
Cytokines play a role in either fueling or suppressing the inflammation that causes damage in rheumatoid arthritis and some other diseases. The release of selected cytokines is impaired by cannabis, but the findings differ by cell type, experimental conditions, and especially the concentration of the cannabinoids examined.[29-32] A sterol/sterolin combination has been experimentally demonstrated to reduce the secretion of the pro-inflammatory cytokines controlled by the TH2 helper cells and to increase the number of TH helper cells that regulate the secretion of antibodies from the B cells. This selective activation and inhibition of the immune system is effective in controlling the dysfunctional auto-immune response.
Similarly, another non-psychoactive cannabinoid, ajulemic acid, has been found by UMass Medical Center researchers to reduce joint tissue damage in rats with adjuvant arthritis. Tests on human tissue done in vitro showed a 50% suppression of one of the body chemicals (interleukin-1beta) central to the progression of inflammation and joint tissue injury in patients with rheumatoid arthritis.
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