Rheumatoid Arthritis:
Arthritis can be characterized in a few different ways depending on which form of arthritis you are talking about. Although all forms of arthritis are typically characterized by inflammation, rheumatoid arthritis (RA) is unique in a sense that it is described as a self-destructive disease. This is due to the fact that autoimmune diseases are characterized by the body’s immune system mistaking healthy tissue for foreign tissues. This ultimately causes the immune system to break down the cartilage lining of your joints, causing painful swelling that can eventually result in bone erosion and joint deformity due to thickening of the joint membrane from chronic inflammation (nodules). The inflammation associated with rheumatoid arthritis is what can also damage other regions of the body if not controlled.
Rheumatoid arthritis (RA) typically begins in the smaller joints and begins to progress itself into the larger joints as the disease progresses and is said to typically have an impact on both sides of the body. Research has also shown that about 40 percent of people who suffer from the disease also experience issues in regions like the skin, bones, kidneys, heart, lungs and nerve tissue. Although there is currently no cure for the disease, new avenues for therapy are constantly being researched and discovered.
Factors that may also increase your risk for RA is your sex, it is said that women are more likely than men to develop RA and that the most common time to see signs and symptoms is between the ages of 40-60. RA, like other autoimmune disorders have a very high prevalence of being passed on to an offspring and should enable that individual to be more proactive against possible instigators of the disease. The three partially preventative factors here are smoking, environmental factors such as, asbestos and world trade center dust exposure (although poorly understood) and obesity. Although these factors cover a broad range of possibilities, some of them posses the ability to improve or be prevented and should be considered if you are at risk for developing RA (Harris et al., 1990 Weissmann et al., 2006).
Psoriatic Arthritis:
Although similar to rheumatoid arthritis in a sense that it is characterized as an autoimmune disease, psoriatic arthritis (PsA) differs due to the fact that it typically occurs in people who have been diagnosed with psoriasis and typically stems from this autoimmune disorder and is considered to be the second most common inflammatory joint disease. However, joint stiffness, pain and inflammation can be present before the typical red scaly skin patches that characterize psoriasis begin to appear. People who develop joint pain associated with psoriasis should consult their physician immediately. Untreated joint pain can lead to long-term disability Veale et al., 2013.
The abnormal immune response typically causes skin cells to rapidly reproduce and triggers the immune system to cause damaging inflammation in your joints, which may ultimately develop into arthritis mutilans if left untreated. Joint damage typically begins to occur early and up to 50% of PsA patients have an 11% annual erosion rate in the first 2 years of disease duration. This progression can develop into arthritis mutilans, which causes damage and deformity to the small bones of the hand causing permanent impairment to the bone and joint structures Veale et al., 2013.
The biggest risk factor for PsA is psoriasis. Although age and environmental factors can play a role like mentioned with rheumatoid arthritis, psoriasis remains the biggest predictor of developing PsA. Although there is no cure for psoriatic arthritis (like other auto-immune disorders), therapeutic and pharmaceutical options for controlling the disease seem to be the main approach to dealing with the pathology of this disease.
Osteoarthritis:
Osteoarthritis (OA) is described as the most common form of arthritis, which affects millions of people worldwide (majority 65+) and has been characterized by the breakdown of protective articular cartilage that protects the ends of your bones. This breakdown from chronic overuse and joint misalignment ultimately causes joint swelling, which leads to chronic pain and inflammation that can further damage the bone structure and the synovium (joint membrane/capsule) Samuels et al., 2008,
It has become apparent that mechanical and genetic factors play a major role in determining outlooks on OA and the primary risk factor for OA is age. The process of aging contributes to OA progression in several ways, the primary being structural and material changes of the bone and joint matrix, ultimately causing inflammation that further alters the bone and joint structure causing severe pain, chronic inflammation and bone and joint deformity.
Although treatment for osteoarthritis ranges from physical therapy, to non-steroidal anti-inflammatory drugs, to joint reconstruction, once the underlying mechanism of OA have taken place the damage will not be reversed. Often time treatment focuses on effectively managing pain with lifestyle changes such as weight loss, natural remedies, diet/exercise and other surgical or therapeutic options.
Where Does Cannabis Come In?
The role of cannabis particularly the constituent cannabidiol (CBD) has been identified to have many therapeutic effects including anti-inflammatory, neuro-protective and anti-tumor effects. This has led to clinical and therapeutic interest amongst the pharmaceutical and osteopathic communities. Studies have identified that oral and topical applications of CBD allow for the accumulation of cannabinoids within the body, which enable indirect interaction with cannabinoid receptors and enable anandamide upregulation (bliss molecule).
Research has explained that CBD plays a role in the modulation of cytokine release, a primary step in the inflammatory-immune response to injury. A study conducted by Hammell et al., 2016 explained that results of a chemical analysis of the spinal cord in mice revealed that dose dependent reductions in pro-inflammatory markers were seen after administering CBD topically over four consecutive days. Additionally, the work conducted by Philpott et al., 2017 explained that administration of CBD blocked osteoarthritic pain and significantly reduced joint inflammation. CBD treatment seems to impede the later development of pain and nerve damage in the osteoarthritic joints. The findings suggest that CBD may be a safe and useful therapeutic treatment of osteoarthritic joints and neuropathic pain associated with chronic inflammation of the joint capsule and bone deterioration.
The potent anti-inflammatory effect of CBD, with inhibition of pro-inflammatory cytokine production observed in experimental arthritis, led investigators to the possibility of CBD effects on autoimmune diseases Mechoulam et al., 2007. Data has suggested that the antiarthritic effect of CBD is due to a combination of immunosuppressive and anti-inflammatory actions. It has been noted in previous findings that CBD may indeed have additional therapeutic action in psoriatic and rheumatoid arthritis due to the effects it has on suppressing over active immune cells. Although further research in human models is needed to prove this, investigators have advocated for the safety and efficacy of CBD for therapeutic applications regarding inflammation, pain and arthritis.
References:
- Weissmann G. The pathogenesis of rheumatoid arthritis. In: Bulletin of the NYU Hospital for Joint Diseases. 2006
- Harris ED. Rheumatoid Arthritis: Pathophysiology and Implications for Therapy. Mech Dis1990;
- Veale DJ. Psoriatic arthritis: Recent progress in pathophysiology and drug development. Arthritis Res Ther2013;
- Samuels J, Krasnokutsky S, Abramson SB. Osteoarthritis: A tale of three tissues. In: Bulletin of the NYU Hospital for Joint Diseases. 2008
- Fernandes JC, Martel-Pelletier J, J.-P. P. The role of cytokines in osteoarthritis pathophysiology.Biorheology2002;
- Hammell DC, Zhang LP, Ma F, et al. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. Eur J Pain (United Kingdom)2016;
- Philpott HT, O’Brien M, McDougall JJ. Attenuation of early phase inflammation by cannabidiol prevents pain and nerve damage in rat osteoarthritis. Pain2017;
- Mechoulam R, Peters M, Murillo-Rodriguez E, Hanus LO. Cannabidiol–recent advances. Chem Biodivers. 2007;4(8):1678-92.
