What is Arthritis
Osteoarthritis, or more often referred to simply as arthritis, is a common but not very well understood condition. Arthritis is not a single disease that is instead referring to a group of symptoms resulting from, and in joint pain and joint disease. There are over 100 types of arthritis with people of all ages, genders, and races suffering from it. However, it is most common among women and develops more frequently with age.
Arthritis is the swelling and tenderness in one or more joints that is accompanied by stiffness and pain. This is most often as a result of the cartilage that covers the ends of bones where they form the joint and/or lining of the bones to break down due to injury, infection, or autoimmune issues.
Arthritis causes permanent changes in the joints and may be visible as knobbly finger joints. However, damage can also be invisible from the outside, and can only be seen on X-ray. In addition, some types of arthritis also move beyond the joints and can also affect other systems and organs including the heart, eyes, lungs, kidneys, and skin.
Types of Arthritis
Arthritis is more than just wear and tear or an old person’s disease and comes in various forms, with differing degrees of severity and symptomology. The two most common are:
- Degenerative Arthritis of which osteoarthritis is the most common type. It is characterized by the wearing away of the cartilage – the slick, cushioning surface on the ends of bones – wear away. This causes the bone to rub against bone, causing pain, swelling, and stiffness. Over time, joints can lose their strength and pain becomes more chronic.
- Inflammatory Arthritis is when the immune system doesn’t work properly and mistakenly attacks the joints with uncontrolled inflammation that eventually erodes the lining and tissues of the joints. Inflammation can also damage internal organs, eyes, and other parts of the body. Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and gout are examples of inflammatory arthritis.
Other, less common types of arthritis include:
- Infectious Arthritis is when a microbial infection such as a bacterium, virus, or fungus enters the joint and triggers inflammation.
- Metabolic Arthritis occurs when excess uric acid builds up and forms needle-like crystals in the joints that result in joint pain and/or gout attacks.
- Psoriatic arthritis is an inflammatory joint condition that can affect people with psoriasis
- Enteropathic arthritis is chronic inflammatory arthritis associated with inflammatory bowel disease (IBD), the 2 main types being ulcerative colitis and Crohn’s disease.
- Reactive arthritis develops shortly after an infection of the bowel, genital tract or, less frequently, after a throat infection
- Secondary arthritis can develop after a joint injury and sometimes occur many years afterward
- Polymyalgia rheumatica is where the immune system causes joint inflammations, muscle pain, and stiffness, usually across the shoulders and tops of the legs.
Symptoms of Arthritis
Symptoms may come and go and can range from mild to moderate or severe that can remain the same for years but will eventually progress and get worse over time. Severe arthritis can cause chronic pain that makes it difficult to perform various types of common daily activities and impede the ability to work.
The most common arthritis joint symptoms include:
- Swelling of the joints
- Pain that can either be acute or chronic
- Stiffness and a decreased range of motion
- Heat and redness of the skin around inflamed tissues
- Weakness and muscle wasting
Arthritis Medications & Treatments
Treatments vary depending on the type of arthritis. The main goals of arthritis treatments are to reduce symptoms and improve quality of life.
Painkillers: Help reduce pain (but have no effect on inflammation) and can include over-the-counter (OTC) options, or for more severe pain, opioids might be prescribed. However, when opioids are used for a long time, they may become habit-forming, causing mental or physical dependence.
Non-steroidal anti-inflammatory drugs (NSAIDs): Reduces both pain and inflammation and most often include OTC NSAIDs like ibuprofen and naproxen. Some NSAIDs are also available as creams or gels, which can be rubbed on joints. Oral NSAIDs can cause stomach irritation and may increase your risk of heart attack or stroke.
Counterirritants: Interfere with the transmission of pain signals from the joint itself and include menthol or capsaicin. Rubbing cream or gel preparations that contain counterirritants on the skin may reduce aching joint pain and inflammation.
Disease-modifying anti-rheumatic drugs (DMARDs): Used to treat rheumatoid arthritis, DMARDs slow or stop the immune system from attacking joints. Examples include methotrexate and hydroxychloroquine.
Biologic response modifiers: Genetically engineered drugs that target various protein molecules that are involved in the immune response. Biological response modifiers are typically used in conjunction with DMARDs.
Corticosteroids: A class of drugs that reduces inflammation and suppresses the immune system. Corticosteroids include drugs like prednisone and cortisone that can be taken orally or can be injected directly into the painful joint.
Regular physical activity, hot and cold compresses, and assistive devices are commonly used to help manage mild, to moderate osteoarthritis symptoms. Osteoarthritis in particular may be managed effectively by staying active, maintaining a healthy weight, and avoiding injury and repetitive movements.
Physical therapy can also be helpful for some types of arthritis with certain exercises improving the range of motion and strengthening the muscles surrounding joints. In some cases, splints or braces may be warranted. Other therapies that are thought to help treat arthritis include acupuncture, glucosamine, chondroitin, yoga, tai chi, and massage.
In severe cases surgery may be necessary and include:
- Joint repair including the smoothing and realigning of joint surfaces to reduce pain and improve function.
- A joint replacement that removes the damaged joint and replaces it with an artificial one. The joints most commonly replaced are hips and knees.
- Joint fusion is where the ends of the two bones in the joint are removed and then locked together until they heal into one rigid unit. This procedure is more often used for smaller joints, such as those in the wrist, ankle, and fingers.
CBD for Arthritis
Research & Scientific Evidence
Several animal studies have shown that cannabidiol (CBD) has powerful pain-relieving and anti-inflammatory properties that can be helpful for managing the symptoms of arthritis. Unfortunately, to date, these effects have not extensively been studies and/or validated in clinical trials on human arthritis patient populations.
In a seminal 2007 paper published in the European Journal of Pharmacology, scientists investigated CBD’s therapeutic potential for neuropathic and inflammatory pain in rats.
Neuropathic and inflamed rats received oral cannabidiol or its vehicle; neuropathic rats received cannabidiol doses of 2.5, 5, 10, and 20 mg/kg, inflamed rats were given 20 mg/kg and the control rats were given a placebo. The CBD treatment/placebo was given once a day for a week, starting from day 7 after neuropathic pain or inflammation was induced. The efficacy of the CBD treatments was assessed using both behavioral and biochemical tests.
The researchers found that CBD produces an anti-hyperalgesic effect in neuropathic and inflamed tissues, possibly via acting as a CB1, CB2, and TRPV1 receptor antagonist. They showed that CBD inhibits the cellular uptake and enzymatic hydrolysis of the endocannabinoid anandamide, which is involved in pain control through activation of cannabinoid CB1 and CB2 receptors. Because of this, the result is enhanced levels of anandamide outside and inside the cell, which in turn accounts for CBD’s anti-hyperalgesic and anti-inflammatory actions.
Investigating the interaction of CBD with the 1-⍺ and ⍺-1-β glycine receptors thought to play a key role in the development of chronic pain following inflammation or nerve injury, the researchers published their results in a 2009 paper in the journal Pharmacology.
The researchers utilized a standard whole-cell experiment protocol to apply a CBD solution to 1-⍺ and ⍺-1-β glycine receptors in human kidney cells. CBD has applied either alone, in order to determine its direct agonistic effects, or in combination with a sub-saturating glycine concentration, in order to determine its glycine-modulatory effects.
From the data, they concluded that CBD targets and modulates 1-⍺ and ⍺-1-β glycine receptors and implicates this interaction for some of its anti-inflammatory and neuroprotective properties. Moreover, because the inhibitory postsynaptic transmission in the spinal cord involves mainly glycine, CBD has the potential as a therapeutic agent that inhibits pain sensitization without producing sedation or other central nervous effects.
Expanding on these previous findings, researchers published the results in a 2012 paper in the Journal of Experimental Medicine on their investigation of the ability of CBD and CBD analogs to suppress inflammatory and neuropathic pain.
After inducing inflammatory and neuropathic pain in mice, the researchers injected them with CBD via intrathecal administration. Several hypersensitivities, locomotor, and other measurement protocols were subsequently analyzed to assess pain levels. Spinal cord slices, biochemical and other molecular analyzes were also performed to investigate the mechanisms underlying CBD’s analgesic, anti-inflammatory, and antihyperalgesic effects.
The data showed that CBD significantly suppresses chronic inflammatory and neuropathic pain via the spinal glycine receptors (GlyRs) that are an important target for the treatment of inflammatory and neuropathic pain. They concluded that their study provided several lines of evidence to suggest that CBD suppresses persistent inflammatory and neuropathic pain by targeting α3 GlyRs, making it a potentially effective pain treatment for patients suffering from diseases such as arthritis.
According to the Arthritis Foundation in the United States, anecdotally, some people with arthritis who have tried CBD, report noticeable pain relief as well as improvements in sleep and/or anxiety symptoms.
CBD as a Complementary Treatment
CBD can also be an effective complementary therapy to help reduce many of the symptoms accompanying arthritis, and the chronic pain that accompanies it. As mentioned, in addition to pain relief, many people also find that CBD reduces feelings of depression, anxiety and mediate sleep difficulties by promoting REM sleep, issues that many people with arthritis also struggle with. CBD can also be of great benefit to patients that take opioid medications, as is to help them reduce the amount of opioid medications while simultaneously aiding in the recovery from any opioid dependencies they might have developed. One particular study concluded that CBD’s anxiolytic properties and minimal adverse side effects support its viability as a treatment option for a variety of symptoms associated with opioid addiction.
Arthritis is a complicated, chronic condition that affects numerous people. Current CBD research has the potential to develop treatments to relieve the two main causal factors in arthritis by targeting pain and inflammation through the body’s own internal cannabinoid, opioid, and vanilloid systems. Before embarking on a course of CBD for treating your arthritis, always speak to your treating physician first. He or she can monitor dosage, symptom improvements, and other clinical parameters such as potential drug interactions to help you manage your arthritis safely and effectively.