Cannabis and Rheumatoid Arthritis
When I was asked to write about RA, I was a little overwhelmed. I started this project knowing so little about the condition. Of course, I hear the commercials that blanket daytime television. The list of side effects, spoken at breakneck speeds, still taking longer to list than the actors paid to sell the good sides of this chemical cocktail. Don’t get me wrong, as skeptical as I am about new drugs, I respect the fact that some people need certain drugs, and really are helped by them.I started this project knowing nothing, so lets learn the basics together.Rheumatoid arthritis, according to Wikipedia.com, is a chronic condition characterized by systemic inflammation, primarily of the joints. It can also cause deformed joints in some cases, as well as damage to other organs, occasionally unbeknownst to patient or doctor.
Currently, researchers aren’t sure what causes RA. They do know the process of the disease causes an inflammatory response of the synovium (the capsule surrounding the joint), which then causes swelling as well as the formation of fibrous tissue. This tissue can cause stiffness and limited range of motion. Erosion and thinning of bones and cartilage, as well as inflammation of the lungs, heart and eyes can also occur.
Diagnosis usually entails a lot of doctors visits, blood tests, x rays and fluid draws. Exclusion of other conditions and disorders, resulting in more tests and expenses, is almost always utilized. It is a lot of time, money, guessing and pain to just obtain a diagnosis.
chronic pain cycle with rheumatoid arthritis is a vicious cycle
A support group, RAChicks.com, recently posted a survey for their users. 55% of respondents say they take between 1 and 5 different medications per day. Another quarter of all respondents take between 6 and 9 different medications every single day. 16% are taking more than 10 medications per day. Only 4% of those responding are free of medications. This is one support group, but it seems to me to ring true with my other searches, and I can only assume its a relatively fair assessment.
Current treatments include non medication therapies such as physical therapy, splints and braces, occupational therapy and dietary changes.
Medications including pain killers, anti inflammatory drugs and steroids can help in suppressing symptoms, but do nothing to stop the progress of the disease. Disease-modifying anti rheumatic drugs (DMARDs) are able to slow, or even halt the progress of the disease, but tend to have a lot of side effects. DMARDS suppress the immune system, and therefore must be stopped if an RA patient gets sick or has any kind of infection. Given that RA tends to have co-morbidity for 15-25% of patients, its hard for some patients, especially those with hypersensitivities to drugs, to have a solid regiment of these medications. There is also very little data available on the side effects of DMARDS, due a lot to their relative newness to the market.
Surgical treatments exist, often arthroscopic, sometimes open synovectomy. This involves the removal of the inflamed synovia and can slow down the deterioration of the effected joint.
Rheumatoid arthritis effects between 0.5% and 1% of people worldwide. Onset usually happens around middle age, but people of all ages have been diagnosed. The first documented case of RA was made in Paris, France by Dr. Augustin Jacob Landré-Beauvais.
All very dry reading, but its important to understand a condition before addressing possible treatments.
Sarah R. (33) from New York her tells of her account with RA –
“I had a severe reaction to a sinus infection and couldn’t walk. I didn’t know what was wrong for 3 months. The rheumatologist sent me for a ton of blood work and diagnosed me 3 years ago. They put me on remicade, methotrexate and naproxin. It kills your immune system and if you get sick you have to stop. The remicade is a form of chemotherapy and methotrexate used to be used for abortions. I started having problems with my asthma and had to stop those. I tried humera and it did nothing. So for now I’m on naproxin as needed and just push through it. I get swelling in my ankles, knees and hands. Getting up is awful until I get moving and at the end of the night my ankles are huge!”
Sarah lives in New York, a state that has yet to put medical cannabis into practice. Even if she was a candidate for relief, and her doctor agreed, she doesn’t even have it as a choice.
So, now we know what RA is and how it can effect a person. And if you are reading this, you are at least mildly curious to know how cannabis effects RA. You shouldn’t be surprised to hear how few actual studies have been done.
It is worth noting that smoking anything, including marijuana, increases your heart rate. One study by the National Drug Abuse Institute, says that for an hour after smoking your heart attack risk increases to 500% that of a persons normal risk. However, The Institute on Drug Abuse has found no studies have linked marijuana use to lung or upper respiratory cancers.There are also many other ways to utilize cannabis. Topical creams, tinctures, edibles, vaporizing, my guy even makes these gelcaps that have medicated coconut oil in them.
A 1999 study conducted at the Institute of Medicine found that marijuana was “moderately well suited for particular conditions,” including pain.
Huffington Post recently reported a story about Steve, who has RA. “I’m an old-man weight lifter,” he says. He lost one of his kidneys after being diagnosed with cancer in 2004. Steve claims to have used marijuana for 30 years, long before this resurgence of acceptance and research. Steve feels his choices are limited to manage his pain. “If my pain is at a 10, it will take it down to a 6 or 6.5. After I smoke I am able to work my shoulders and arms to keep my joints healthy. It gives me the desire and ability to get through a workout.” Steve smokes everyday, more at night than during the day. It helps him sleep and relives his pain, but he does report a “couch lock” experience sometimes. “It makes you lazy.”
Patients with kidney problems can still take DMARDs, says Ogechi “Helen” Mbakwe, M.D., from Central Washington Internal Medicine and Endocrine Center, as long as their dose is adjusted and they are monitored closely. However, Dr. Mbakwe, who practices in a medical marijuana state, is one of the many who are reluctant to prescribe marijuana. While many arthritis patients swear by the medical benefits of marijuana, the FDA issued a statement claiming it “has no accepted medicinal value in treatment in the United States, and evidence that there is a general lack of accepted safety for its use even under medical supervision.” These safety issues range from issues of dosage (thc and cbd levels can vary from about 10% to 25+%. Most reputable dispensaries and caregivers will have a label, or at least someone informed on this information) to quality control (mold and parasites can be an issue for even the most discerning grower) to tolerance (blood levels of users can range from from an estimated 7 ng/mL to 100 ng/mL). These are valid concerns. All things should be handled safely, checked often and monitored by at least the user. “Rheumatologists should advocate for further study of individual cannabinoid molecules whereby dosing can be accurately controlled and efficacy and safety can be assessed using standard scientific method,” Fitzcharles
Medical director of the Los Angeles–based Comprehensive Pain Relief Group, Gregory A. Smith, M.D., is a pain management and addiction specialist. He says in a Huffington Post article, “Marijuana does not have that kind of chemical reaction in the brain. It is safer than a lot of the prescription narcotics that I detox people from.”
According to arthritistoday.org, despite these risks, a 2011 Journal of Pain survey says that almost 10% of RA patients responding who needed pain management, use cannabis alone or in conjunction with other treatments.
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