Cannabinoids for the treatment of rheumatic diseases — where do we stand?

Abstract

As medical use of cannabis is increasingly legalized worldwide, a better understanding of the medical and hazardous effects of this drug is imperative. The pain associated with rheumatic diseases is considered a prevalent indication for medicinal cannabis in various countries. Thus far, preliminary clinical trials have explored the effects of cannabis on rheumatoid arthritis, osteoarthritis and fibromyalgia; preliminary evidence has also found an association between the cannabinoid system and other rheumatic conditions, including systemic sclerosis and juvenile idiopathic arthritis. The potential medicinal effects of cannabis could be attributable to its influence on the immune system, as it exerts an immunomodulatory effect on various immune cells, including T cells, B cells and macrophages. However, the available evidence is not yet sufficient to support the recommendation of cannabinoid treatment for rheumatic diseases.

Key points

  • Cannabinoids can affect the proliferation, apoptosis and cytokine production of immune cells, acting as possible immune modulators.

  • Preclinical data suggest that cannabinoids possess therapeutic potential in the following rheumatic diseases: rheumatoid arthritis, osteoarthritis, systemic sclerosis and fibromyalgia.

  • Clinical data regarding cannabinoid treatment for rheumatic diseases are scarce; therefore, recommendations concerning cannabinoid treatment cannot be made.

  • Cannabinoid treatment should not be taken lightly; special consideration and advise are required regarding adverse effects and drug interactions.

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Fig. 1: Endocannabinoid signalling via cannabinoid receptor 1.
Fig. 2: Adverse effects of cannabinoids.
Fig. 3: Interactions of cannabinoids and other drugs.

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Acknowledgements

The authors thank E. Israeli for his comments on the manuscript.

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Y.S., D.K.-T. and I.K. researched data for and wrote the article. D.K.-T. and Y.S. substantially contributed to discussion of content. All authors reviewed and edited the manuscript before submission.

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Katz-Talmor, D., Katz, I., Porat-Katz, B. et al. Cannabinoids for the treatment of rheumatic diseases — where do we stand?. Nat Rev Rheumatol 14, 488–498 (2018). https://doi.org/10.1038/s41584-018-0025-5

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