10 Best CBD Oil for Arthritis: Top CBD Brands Reviewed 2022
Arthritis is a severe and debilitating condition that can affect people of all ages (although it’s more prominent in older individuals). The latest statistics from the Centers for Disease Control (CDC) reveal that up to 58.5 million Americans over 18 had some form of arthritis in 2015.
But an aging population coupled with the repetitive daily tasks we perform—such as computer work or physical labor – likely means the number will be much higher now in 2022. Alarmingly, the CDC predicts that arthritis patients will hit 78.4 million by 2040.
Numbers aside, it’s pretty clear that arthritis poses a considerable risk to people’s health, and it’s not going away anytime soon.
Although research is still ongoing, there’s strong anecdotal and preliminary evidence suggesting CBD may help address some of the symptoms associated with arthritis. As a result, cannabidiol may be a viable alternative for those concerned about medication side effects or dependence on painkillers.
To effectively address arthritis symptoms, you need a CBD oil that’s potent, pure, and safe. Unfortunately, there are now thousands of brands, making it hard to find quality products. We’ve compiled our ten best choices for CBD oil based on several benchmarks to measure quality, strength, safety, and transparency to narrow down the list.
Is CBD Oil Good for Arthritis?
We can’t conclusively say CBD oil is good for arthritis, but the ever-growing pile of preliminary research seems to support that conclusion. It’s also important to consider the mounds of anecdotal evidence that poured in long before experts took CBD seriously. Judging by the number of people who use CBD for arthritis pain and inflammation, the case for cannabidiol gets stronger every day.
For example, an Arthritis Foundation poll surveyed several arthritis patients, revealing some surprising information. According to the survey, 79% of respondents “are currently using CBD, have used it in the past or are considering using it.” Meanwhile, 29% say they currently use it for arthritis symptoms.
Interestingly, the products used are almost evenly split between oils and creams. Of the active CBD users polled, 62% use liquid CBD (oils, tinctures, beverages), while 55% use topical CBD products (creams, balms, lotions).
How CBD Oil Helps with Arthritis
If you plan to try CBD oil for arthritis, it’s helpful to understand how CBD oil helps with arthritis. The mechanism of action is a lot more complex than with other cannabinoids, like THC. But that’s one of the many reasons CBD is so versatile.
Most cannabinoids bind to the CB1 and CB2 receptors that form our endocannabinoid system. This network of receptors and internally-produced cannabinoids keeps our body in balance or “homeostasis.”
THC, for example, binds to both the CB1 and CB2 varieties. Some cannabinoids bind to one or the other. CBD, however, has little affinity for either. Instead, it works through different receptor pathways, including:
● GPR-55 orphan receptors
● TRPV1 vanilloid receptors
● PPAR receptors
● Serotonin receptors
Those pathways serve several functions, including pain regulation, appetite, sleep, and mood to name a few. In the case of arthritis, however, the TRPV1 or “vanilloid” receptors are primarily responsible for mitigating the condition’s symptoms. Researchers induced inflammation in rat subjects during a 2009 study published in the British Journal of Pharmacology.
Based on the observations, CBD’s interaction with the TRPV1 receptors contributed to the anti-inflammatory benefits that also helped reduce pain.
Inflammation is a textbook arthritis symptom inevitably accompanied by pain. Evidence suggests that CBD may help reduce joint pain related to arthritis. For instance, a 2017 research paper in the academic journal Pain studied the anti-inflammatory properties of CBD. Experts applied a CBD-infused topical on rats with osteoarthritis. Although the rodents didn’t show immediate improvement, observers noticed a significant reduction in inflammation by the 14th day of their experiment.
Analgesic 2019 Gallup poll shows 14% of Americans use CBD. But out of all the potential symptoms, 40% of those CBD consumers—the most significant chunk—use it for pain.
This pattern is even more prominent when you look at the Arthritis Foundation’s poll we covered earlier. That survey determined 94% of CBD users with arthritis took cannabidiol for pain.
But one notable piece of research is a 2008 review of existing literature by famous cannabis researcher and medical expert Ethan Russo. Russo is known for “Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects,” a paper where he proposed and explained the synergistic “entourage effect” that we frequently refer to today.
Russo examined studies on synthetic (prescription) cannabinoids and external cannabinoids (phytocannabinoids). Unsurprisingly, he concluded that, based on existing evidence, CBD and other cannabinoids might help manage chronic pain.
CBD was far from mainstream in 2008, but subsequent research—such as that mentioned above—has helped support Russo’s conclusions.
Best CBD Oil for Arthritis: Top CBD Brands Reviewed
If you’re looking to try full-spectrum CBD oil for arthritis pain, it’s hard to find the right product—especially if you’re new to CBD. You need a clean, tested, potent CBD oil for the best results.
To help determine the best CBD oil for arthritis, we’ve compiled a list of top ten vendors based on our objective benchmarks (more on that later).
1. Colorado Botanicals: Best CBD Oil for Arthritis
Colorado Botanicals was established in 2017, offering a trustworthy and effective line of inexpensive Full and broad-spectrum CBD products. Today, they carry an even more extensive selection of hemp supplements, but they have never wavered from their commitment to transparency, safety, and quality. We’re proud to give Colorado Botanicals our top spot as the Best CBD Oil for Arthritis.
Colorado Botanicals offers the best CBD oil for pain (or other possible uses). But we’re not the only ones to notice. Observer and Discover Magazine chose Colorado Botanicals as their top pick as “Best CBD Oil” and “Best CBD Oil for Pain,” respectively.
But Colorado Botanicals advantage isn’t just what you see on their shelves. Behind the scenes, those products are backed by quality assurance, sustainable farming, independent testing, and lab-grade production.
CO2 extraction is becoming the primary approach to quality CBD oils. It leaves no trace solvents, making it cleaner – albeit more complicated – than other methods. Unfortunately, the process also destroys many terpenes, cannabinoids, and other beneficial compounds. Typically, vendors artificially add terpenes from other plants to make up for the loss.
However, Colorado Botanicals perfected a proprietary CO2 extraction technique followed by an unmatched purification process that maximizes terpene, cannabinoid, and flavonoid retention for an all-natural product.
Colorado Botanicals full-spectrum CBD oil ranges in potency from 300 to 3,000mg of CBD per 30 ml bottle, but their 750mg Full-Spectrum CBD Oil—at 25 mg/ml—is strong enough to meet the needs of an average CBD user.
The already low price gets better with repeat shipping at a 15% discount.
Based in Denver, Colorado, CBDistillery has grown by leaps and bounds since its founding in 2016. CBDistillery focuses on quality sourcing. They use Colorado hemp grown through “natural farming practices,” although they never mention “organic.” The vendor is also certified by the U.S. Hemp Authority.
All of the company’s CBD oils are very affordable. Veterans and active military personnel may further offset the cost with CBDistillery’s 30% military discount.
Regular customers can also save money by subscribing to a 20% discount on every order.
CBDistillery offers excellent value along with a range of CBD extract products. However, we feel the best option is their mid-range product. CBDistillery’s 1,000mg Full-Spectrum CBD contains 33 mg/ml of CBD, allowing it to address mild to moderate symptoms.
3. NuLeaf Naturals
Established in 2014, NuLeaf Naturals keeps its products pure and simple. Although they were strictly CBD-focused, their offerings expanded to CBG, CBN, and CBC oils. NuLeaf’s approach to hemp CBD is similar to that of Colorado Botanicals. Both prefer to focus on purity rather than flavors and other proverbial bells and whistles. One thing they haven’t done is expand beyond oils, topicals, and capsules. But this isn’t necessarily a bad thing. Rather than branch out to new options, they continue refining and perfecting the products that made them successful. Unfortunately, this can limit their customer base, but those that are loyal can expect to enjoy some of the purest CBD oils available. If you’re looking to try Nuleaf Naturals CBD oil, their 900mg Full-Spectrum CBD Oil is a perfect mid-range starting point.
4. Lazarus Naturals
Based out of Seattle, Lazarus Naturals grows its organic hemp in Oregon.
They offer CBD and other cannabinoid extracts in various sizes and options. Like most premium CBD vendors, they’ve since expanded into other extracts, adding CBG and CBN to some of their formulations.
One thing that stands out about Lazarus Naturals is their price. Customers can pick up a bottle of full-spectrum 2,400 mg 60 ml CBD oil for just $120.00. Lazarus Naturals also has one of the best return policies possible. You can return your unwanted items for free with a prepaid shipping label up to 90 days after receiving them.
We recommend the Lazarus Naturals High Potency 1,500mg Tincture. All of the oil products in this line contain 50 mg/ml, so our choice is based on volume and price.
5. Charlotte’s Web
Charlotte’s Web is one of the most established CBD brands. Originally opening in 2012, their high-CBD cannabis strains put cannabidiol on the map. The brand rose to prominence after a story went public about Charlotte Figi, a young girl whose severe epilepsy was controlled by the company’s CBD oil.
Charlotte’s Web isn’t the cheapest brand, but it’s not prohibitively expensive either. It helps that they offer a 20% discount for subscribers and an assistance program for veterans.
Charlotte’s Web sells 30 or 100 mg bottles in 7, 17, 25, 50, and 60 mg/ml concentrations. In our view, however, the best mid-range choice is their THC-Free CBD Oil at 25 mg/ml. The broad-spectrum product is perfect for moderate users and carries no THC.
6. Joy Organics
Joy Organics is among the few who can say their hemp is USDA Certified Organic, the highest tier possible.
Like CoBo, Joy says they use a proprietary CO2 extraction method that maximizes natural hemp compound retention. Of course, you can see that with lab test results available on each product page.
The company also offers decent potency options, ranging from 15 mg/ml to 75 mg/ml – all at surprisingly affordable prices. Customers can save even more with Joy’s 20% discount for subscribers.
We highly recommend Joy Organics Full-Spectrum 1350 MG Fresh Lime Organic CBD Tincture, popular among customers looking to try CBD for arthritis pain.
At 45 mg per serving, the product’s potency offers an excellent balance for beginners and intermediate CBD enthusiasts.
cbdMD embodies what success in the industry should look like. Opening in 2015, their company grew exponentially and now offers a diverse selection of CBD oils, edibles, skincare products, and more.
As far as potency is concerned, cbdMD tops our list. Their most potent product (7500 mg) contains a staggering 250 mg/ml in a 30 ml bottle – far above the 100 mg/ml cap we’ve seen so far with other companies.
Considering what they offer, cbdMD is quite affordable, with their strongest oil retailing for just $209.99 – a price that’s much lower with their 30% subscriber discount. The cbdMD Premium 750 mg CBD Oil Tincture is a solid medium-dose product that may help people who are trying to address arthritis pain and other symptoms. At 25 mg/ml, the concentration isn’t excessive for beginners yet also adequate for those with moderate needs.
Established in 2017, Medterra is a bit of a youngster compared to some of its competitors. But despite its comparative inexperience, the CBD company has a lot to offer. Medterra only carries a handful of CBD products, but their formulas reflect the more advanced recipes that many companies adopted. Certain lines include other beneficial ingredients, like CBG and nutritional supplements.
What truly stands out about Medterra is its commitment to education. Their site is crammed with resources and news for beginners new to CBD. With such tools, it’s easy for anyone to get their feet wet as they enter the ever-growing world of hemp-derived CBD health supplements.
Customers looking for full-spectrum CBD oil can choose Medterra’s True Full-Spectrum oil at 50 mg/ml. The product is only available in 50 and 100 mg/ml doses, with 2 mg of THC per serving.
9. Royal CBD
Royal CBD’s commitment to quality is pretty straightforward. As their slogan states: “no room for mediocrity,” it’s evident that they take their products seriously. Despite the rather intense tone, it offers a sense of reassurance. Their commitment to quality is transparent, with CO2 extraction, natural sourcing, and third-party tests integral to their business.
Royal CBD offers decently potent oils. At up to 83 mg/ml in broad-spectrum and full-spectrum CBD options, they sit in the upper tiers but don’t approach the solid 100 mg/ml of CoBo, or cbdMD’s 250 mg/ml concentration.
Royal CBD’s 1,000 mg Full-Spectrum CBD Oil is a good balance between price and potency – although, at $129.00, it’s a bit expensive. Still, the product contains 33 mg/ml of CBD, an excellent mid-sized dose.
10. Green Roads
Green Roads may not have the same chops as some bigger names, but it makes up for that with its experience, knowledge, and exciting backstory.
Founded in 2013 by pharmacist Laura Fuentes, she was inspired to enter the industry after a friend with health issues approached her for help. What started as a side gig formulating products in her spare time soon became the thriving business we see today.
Green Roads carries isolate, broad-spectrum, and full-spectrum tinctures. We recommend Green Roads 1500mg Broad Spectrum CBD Oil, which contains a solid 50 mg/ml of CBD.
How We Chose the Best CBD Oil for Arthritis
Whether you’re looking for arthritis pain or other chronic pain management, you need the best CBD products. But sorting through the sea of companies is challenging and time-consuming – so we did that for you.
To remain objective, our rankings are based on a specific set of criteria, which determines a CBD vendor’s rank on our list.
An easy way to find the best CBD companies is through company reputation. It’s easy for any CBD retailer to say they’re the best or post reviews on their websites. However, we avoid potentially biased sources and instead focus on independent forums, like Reddit or Trustpilot.
That being said, some companies – while excellent – are still building a place in the market, so company reputation doesn’t carry the same weight as some of our other benchmarks.
Third-Party Lab Reports
Third-party lab reports are necessary for a CBD retailer to make it anywhere near our list. These tests are critical for transparency and safety. Without concrete proof, any vendor can assure us of their products’ quality, accuracy, and purity.
Lab reports should be clear, easy to read, and from a reputable third-party lab. Some vendors do their in-house testing, but that’s a recipe for bias. The tester’s information is supposed to be listed on the test document, making it easy to check with a simple Google search.
Product testing is tied to third-party lab reports. Lab reports won’t exist without a testing process – unless they’re forged, which sadly has been known to happen. Like reports, testing is an absolute must-have. Hemp extracts can contain any number of contaminants, like bacteria, fungi, and heavy metals. It’s also impossible to confirm CBD content without testing the extract first.
Any vendor that doesn’t test its products should be avoided.
While company reputation focuses on brand recognition through customer volume, customer reviews determine whether a vendor—known or obscure—is worth supporting. Again, we base our evaluations on independent feedback from sources like Reddit or other consumer review forums.
Although we understand every company has its share of bad ratings, a large customer base and overwhelmingly positive responses indicate a reputable business.
CBD Oil for Arthritis FAQs
How much CBD oil to take for arthritis?
The amount of CBD oil to take for arthritis is tricky to determine. Conventional medications receive extensive study and are designed to behave a certain way, making dosing easy and predictable.
CBD, however, hasn’t had the same level of research as any medicine you’ll find at your local drugstore – prescription or otherwise. And the information we do have only indicates that textbook CBD dosing is all but impossible.
Many factors affect the correct dose, including:
● Sensitivity (to CBD)
Our endocannabinoid systems are also unique to each of us, further complicating the dosing issue.
Start Low and Go Slow
CBD is biphasic, meaning that too much CBD is just as ineffective as taking too little. That’s why it’s essential to follow the old cannabis adage, “start low and go slow.” If you’ve never experienced CBD before, start with the smallest dose possible – around 2.5 to 5 mg. Increase that dose gradually over several days until you notice results.
When is the best time to take CBD oil for arthritis?
If you suffer from constant flare-ups, your goal will be to keep a steady supply of CBD in your body to hopefully mitigate the pain and inflammation. There’s no right or wrong time to take CBD, but consumers find it works better when taken with food.
Eating something fatty, like peanut butter, also helps speed up absorption since CBD (like all cannabinoids) needs some kind of lipid to carry it.
What is the best way to take CBD for arthritis?
The best way to take CBD for arthritis is through oral ingestion. This approach allows CBD to provide a more generalized anti-inflammatory and analgesic effect. Oils aren’t the only option. Many CBD edibles are available that make taking CBD easier for those who aren’t fans of the “hempy” oil flavor. To that end, CBD gummies are a fantastic alternative.
If you want the best CBD gummies for pain, keep our benchmarks in mind while shopping around. However, topicals are also a practical option for fast, focal relief of joint pain and inflammation. Although they’re not as long-lasting as CBD oil, topicals work almost instantly, right where you need them.
Both oils and topicals are excellent products, but using them together is the best way to prevent arthritis symptoms and quickly address them should they arise.
Does CBD have side effects?
Yes, CBD has side effects. Fortunately, they’re rare and relatively mild. Some examples include:
● Appetite change
● Mood changes
One concern is CBD’s potential interaction with certain prescription medications, such as antiepileptic drugs (AEDs). If you’re on any medicines, speak to your doctor or specialist before trying CBD.
Conclusion: Best CBD Oils for Arthritis of 2022
It’s tough to find the best CBD oils for arthritis. Shopping for the right one can be overwhelming with so many products, brands, and sources. The easiest way is to look for specific indicators of quality, credibility, and safety.
But the world of cannabinoid hemp supplements is rapidly expanding. CBD laid the groundwork, which has since paved the way for other related products. Cannabigerol (CBG) several brands—like those above—created some of the best CBG oil available, which could further help mitigate arthritis symptoms.
While there’s no guarantee CBD will work for you, being a smart shopper increases your chances of seeing positive results.
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Complementary treatments and arthritis – from turmeric to cannabis oil
People use complementary medicine for many different reasons, including:
- wanting to use more natural treatments
- their symptoms aren’t fully controlled by conventional medicine.
Read more about complementary therapies which can help to ease the symptoms of arthritis, from yoga to meditation.
Are they right for me?
As with all complementary treatments, different things work for different people and it isn’t possible to predict which might be the most useful or effective.
There are some key points to consider if you’re thinking about using any complementary treatments.
- What are you hoping to achieve? Pain relief? More energy? Better sleep? Reduction in medication?
- What are the financial costs?
- Is there any evidence for their effectiveness?
Are complementary medicines safe?
Complementary medicines are relatively safe, although you should always talk to your doctor before you start any new treatment.
In specific cases they may not be recommended, for example, if you are pregnant or breastfeeding, or they may interact with certain medication.
A starter for five
Here we share a spotlight on the most popular complementary medicines that people call our helpline about.
It’s thought that turmeric can possibly reduce inflammation, which could help people with arthritis.
People with knee osteoarthritis who took part in a research trial reported improvements to their pain levels after taking turmeric. The evidence is limited however, as it is from just one trial. What evidence there is suggested that people only had minor side-effects after taking turmeric.
Turmeric can be bought from health food shops, pharmacies and supermarkets in the form of powder.
Glucosamine sulphate and glucosamine hydrochloride are nutritional supplements. Animal studies have found that glucosamine can both delay the breakdown of and repair damaged cartilage.
The results for the use of glucosamine for osteoarthritis are mixed and the size of the effect is modest. There’s some evidence that more recent trials and those using higher-quality methods are less likely to show a benefit.
Capsaicin is taken from chilli peppers. It works mainly by reducing Substance P, a pain transmitter in your nerves. Results from randomised controlled trials assessing its role in treating osteoarthritis suggest that it can be effective in reducing pain and tenderness in affected joints, and it has no major safety problems. Evidence for its effectiveness for fibromyalgia is related to a single trial.
Other names: Axsain®, Zacin®, chilli, pepper gel, cayenne
Capsaicin is licensed in the UK for osteoarthritis and you can get it on prescription in the form of gels, creams and plasters.
There are no major safety concerns in applying capsaicin gel/cream. A review of capsaicin applied to the skin to treat chronic pain (not specifically related to osteoarthritis, rheumatoid arthritis or fibromyalgia) concluded that around one third of people experience a reaction around the area where the treatment is applied. It’s important to keep capsaicin away from your eyes, mouth and open wounds because it will cause irritation. There have been no reported drug interactions.
Fish oils are rich in omega-3 essential fatty acids, which have strong anti-inflammatory properties. Fish liver oil is also a rich source of vitamin A (a strong antioxidant) and vitamin D (which is important for maintaining healthy joints).
Evidence suggests that fish body oil can improve the symptoms of rheumatoid arthritis. Unconfirmed evidence also suggests a combination of fish body and liver oils might also be useful in the long term, particularly in reducing the use of non-steroidal anti-inflammatory drugs (NSAIDs). There isn’t enough evidence for the use of fish liver oil for osteoarthritis.
Omega-3 fatty acids also play a role in lowering cholesterol and triglyceride levels in your blood, so they can reduce the risk of heart disease and stroke in people with inflammatory arthritis.
In the UK, dietary guidelines recommend eating two portions of fish a week, including one oily. Fish oil is considered to be well tolerated at this dose.
At the correct doses, side-effects are usually minor and uncommon.
Cannabis oil (CBD)
CBD is type of cannabinoid – a natural substance extracted from the cannabis plant and often mixed with an oil (such as coconut or hemp) to create CBD oil. It does not contain the psychoactive compound called tetrahydrocannabidiol (THC) which is associated with the feeling of being ‘high’.
Research in cannabinoids over the years suggests that they can be effective in treating certain types of chronic pain such as pain from nerve injury, but there is currently not enough evidence to support using cannabinoids in reducing musculoskeletal pain. We welcome further research to better understand its impact and are intently following developments internationally.
CBD oil can be legally bought as a food supplement in the UK from heath food shops and some pharmacies. However, CBD products are not licensed as a medicine for use in arthritis by MHRA (Medicines and Healthcare products Regulatory Authority) or approved by NICE (National Institute for Health and Care Excellence) or the SMC (Scottish Medicines consortium).
We know anecdotally from some people with arthritis, that CBD has reduced their symptoms. If you’re considering using CBD to manage the pain of your arthritis, it’s important to remember it cannot replace your current medicines, and it may interact with them, so please do not stop/start taking anything without speaking to a healthcare professional.
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Cannabis for Arthritis: Why Don’t We Know More by Now?
Doctors and patients need high-quality studies specific to rheumatic disease, research finds.
Scientists haven’t been able to study medicinal cannabis in many people with inflammatory arthritis conditions like RA. Marc Tran/Stocksy
It’s currently legal in 37 states and the District of Columbia. People are increasingly knowledgeable about its options, such as edibles and indica versus sativa (two of its strains). And those with rheumatoid arthritis (RA) and other rheumatic diseases are eager to try it.
Yet what is scientifically known about the medical use of cannabis products for rheumatic conditions can fit on a pinhead.
That’s the essential conclusion of a review article on the state of cannabis research for rheumatic diseases. The article was published online April 29, 2022, in Current Rheumatology Reports .
It’s Not Shocking That There Isn’t More Known About Cannabis
“I was disappointed but not surprised” by the low level of research, says W. Benjamin Nowell, PhD, the director of patient-centered research at the online arthritis community CreakyJoints and a lead author of the review.
Understanding the medicinal effects of cannabis is an important topic, Dr. Nowell says, because the question of “whether people should use it for pain and sleep disturbances related to a rheumatic disease is raised by patients and physicians all the time.”
Can It Help Ease Pain? Will It Improve Sleep? People With RA Are Interested in Cannabis
The fact that people with RA are extremely interested in cannabis was documented by CreakyJoints several years ago, when its patient-centered ArthritisPower Research Registry, where Nowell is a principal investigator, queried people online.
The results, presented at the 2019 Annual European Congress of Rheumatology (EULAR) meeting in Madrid, Spain, with an abstract published in Annals of the Rheumatic Diseases, found that 57 percent of survey respondents reported trying marijuana or cannabidiol (CBD) for medicinal purposes.
A key reason for their use: to address symptoms, especially pain, that were not resolved with other medications. Some 18 percent of respondents who used cannabis said they did so because nothing else they tried had worked.
With the growing interest from people living with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and other inflammatory conditions, rheumatologists are often asked to provide guidance on cannabis use, Nowell says. This is important because people with chronic inflammation regularly take a number of medications, and it’s possible that cannabis might interfere with those drugs, he says. Yet doctors cannot provide comprehensive guidance because sufficient high-quality research on cannabis for pain, and particularly for people with a rheumatic condition, has not been done, the review article found.
Legal Status of Cannabis Makes It Hard to Study
A major reason for the paltry research is that cannabis remains illegal at the federal level, even though many states have given it the green light. This makes it difficult for researchers to get funding and approval for studies, and to get consistent, high-quality cannabis to use in research, Nowell says.
“I’m hoping the federal government will make changes — maybe due to increasing public pressure from patients and advocacy from physician groups — that its current legal status is complicating things. Physicians can’t live up to their oath without a better understanding of how this product actually works,” Nowell says.
Little Research on Cannabis for Joint Pain and Inflammation in Recent Years
The review article examined research done on cannabis for rheumatoid conditions or for symptoms like pain experienced by many people with the condition.
It found laboratory studies documenting that cannabinoids reduce pro-inflammatory cytokines and animal studies in mice showing reduced pain responses and inflammation from cannabis products.
But there was only one randomized clinical trial — considered the highest quality evidence in medicine — and it was small, with just 31 people with RA randomized to the medicinal cannabis and 27 to the placebo group. Nonetheless, the study did find that cannabis produced statistically significant improvements in pain during movement and during rest and on quality of sleep, although not on pain intensity and stiffness.
“Prospective studies including randomized clinical trials are very rare, and that’s what we need,” Nowell says. “Doctors need to have information from good research to give to patients, and right now that’s a big black hole for rheumatic conditions.”
There’s Some New Research Underway
The good news is that several, albeit small, studies are currently being planned, according to the federal website ClinicalTrials.gov. One study has already started recruiting patients and another, testing CBD, has not yet begun.
Other Research Has Surveyed Cannabis Users
Some published studies have looked at the patient experience, although they are not randomized controlled trials. For example, Israeli researchers reported in Pain Research and Management in September 2021 that of some 300 people visiting an outpatient rheumatology clinic who use medical cannabis, the majority reported significant improvements to pain levels and sleep (with those taking the highest dosage, 36 grams, reducing pain the most, at 83 percent).
When Chilean researchers examined studies on the topic, they similarly found only one randomized clinical trial, with the rest being patient experiences, leading them to report in the Journal of Clinical Rheumatology in March 2022 that “the evidence is very uncertain.”
And a look at one group of 40 people with pain from osteoarthritis, not RA, found their opioid use declined after they started using medical cannabis, researchers reported in Cureus in January 2022.
Another survey of cannabis use in people with chronic inflammatory arthritis (psoriatic arthritis, ankylosing spondylitis, or RA) has been completed, although results are not yet available.
Fatigue, Constipation, and Other Negative Effects of Cannabis Were Also Reported
The review article makes clear that cannabis interactions with drugs commonly used by people with RA — including DMARDs, gabapentin, and antidepressants — has not been studied at all.
It also describes side effects found in some research in people taking cannabis, including constipation and fatigue, which may be more common in people with RA, impaired driving, and, more rarely, heart rhythm disturbances and psychosis.
One Subgroup Should Definitely Avoid Medical Cannabis
Changes in brain development in adolescents and impairments to newborns when pregnant women use it are reasons people under 25 should not use medicinal cannabis, Nowell says.
Patients Feel More Comfortable When Their Doctor Talks With Them About Cannabis
Because of the trust people have in their physicians and because doctors know about their symptoms and the medicines they are already taking, people want to be able to talk about this option with their doctor, Nowell says.
In fact, in the ArthritisPower survey, some 10 percent of people using medical marijuana stopped doing so because their doctor was not in favor.
Cannabis Doesn’t Replace a DMARD
The review article includes advice for physicians, taken from similar guidance offered by the Canadian Rheumatology Association.
It stresses the notion that doctors should discuss the topic in an empathic, nonjudgmental manner, but that they should offer other, better-tested options for controlling pain first, including nondrug methods such as cognitive behavioral therapy (CBT) and mindfulness.
Most importantly, it emphasizes that medical cannabis is not a substitute for guideline-based therapies for RA.
“I worry a patient might stop using something we know is effective for the underlying disease, like a prescribed biologic, and have cannabis gummies instead,” Nowell says, even though there are no studies documenting how cannabis affects RA and its symptoms. No one should take cannabis in lieu of a treatment that is managing the condition and should always talk to their healthcare provider about all medications, he says.
Still, with many people aware of the potential benefits of cannabis, it might be something a person experiments with, in consultation with their physician, to relieve symptoms that other medicines and approaches have not resolved, Nowell says.