As CBD has grown in popularity over the years, major organizations like the Arthritis Foundation have released guidelines on the usefulness and dosage of cannabidiol (CBD) for rheumatoid arthritis (RA). Cannabidiol (CBD) is a non-psychoactive component of cannabis. The CBD in most products is extracted from hemp, a variety of cannabis that has only traces (up to 0.3%) of THC, the active compound that gets people high. Studies have shown CBD can help reduce chronic pain by impacting endocannabinoid receptor activity, which also reduces inflammation and can potentially help rheumatoid arthritis (RA). This means CBD inhibits inflammation and neuropathic pain.
CBD comes in different forms, including oil, vape, edible, and topical. Oils, vapes, and edibles are taken orally, while topical CBD like lotions can be applied to the skin. CBD dosage varies depending on the type of CBD, reason for usage, and specific medications being used.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis is is an autoimmune and inflammatory disease, where the immune system attacks healthy cells in the body and causes inflammation. RA mainly attacks the joints, usually many joints at once. RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue, which can cause long-lasting or chronic pain, unsteadiness, and deformity. RA can also affect other tissues throughout the body and cause problems in organs such as the lungs, heart, and eyes.
Health Benefits of CBD for RA
Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated with quality studies in humans. Anecdotally, some people with arthritis who have tried CBD report noticeable pain relief, sleep improvement, and anxiety reduction.
The trials that have been conducted in humans have not yielded strong evidence for the use of CBD in managing arthritic pain. A randomized trial of topical CBD for osteoarthritis of the knee lasted only 12 weeks, and results were mixed. One of the largest reviews examining the health effects of cannabis and CBD concluded that there is substantial evidence that cannabis is an effective treatment for chronic pain in adults. There was, however, no specific conclusion regarding CBD, presumably because definitive studies were not available.
Research in this area is ongoing. More recently, a new study showed that CBD can potentially help alleviate rheumatoid arthritis pain and inflammation by acting on immune cells that are attacking healthy cells in the body. It’s important to note that this study was also not conducted with human subjects.
In the absence of high-quality evidence in human studies, it’s difficult to pinpoint the exact dosage and because CBD is an unregulated supplement, it’s hard to know exactly what you are getting when you buy CBD products. If you are interested in trying CBD for RA pain management, be sure to talk to your doctor first before using any CBD products.
Rising Popularity of CBD for RA
In 2019, the Arthritis Foundation conducted a national survey of 2,600 people, where 79% of respondents said they were using CBD, have used it in the past, or were considering using it to help with their arthritis pain.
Health Benefits Related to Arthritis
A lot of anecdotal evidence shows that CBD products have anti-inflammatory effects and can reduce arthritic pain. Given the lack of strong scientific evidence supporting the use of CBD, CBD should not be your first choice for pain relief. It is more appropriate to consider it if other treatments have not been effective enough.
People with rheumatoid arthritis should not stop taking prescribed medications that may be protecting their joints from future damage. They should discuss any changes to their medication regimen with their doctor.
Additional Health Benefits
The strongest scientific evidence for CBD is for its effectiveness in treating childhood epilepsy syndromes such as Dravet syndrome and Lennox-Gastaut syndrome, which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and in some cases it was able to stop them altogether. Recently, the FDA approved the first ever cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.
Other health benefits of CBD include:
Possible Side Effects
There have been reports of mild side effects of CBD. Use of CBD should be started slowly and under the supervision of a doctor to oversee and discuss any concerning or unpleasant side effects you may experience.
The most common side effects include:
These side effects are mild and happen most commonly at the first or first few uses of CBD. It’s important to note that CBD may interact with other drugs, including prescribed medications for rheumatoid arthritis.
Warnings and Interactions
There are some warnings and adverse drug interactions to be aware of before beginning using CBD to manage pain associated with rheumatoid arthritis.
Do not stop any other medications or treatment without consulting a doctor. Additionally, CBD shouldn’t be a replacement for other therapies you are using.
Pregnant people and children should consult a doctor before using CBD since there isn’t enough research on the effects of CBD on these populations. There has been concern about a possible link between inhaled cannabis and lower-birthweight babies, but it’s not clear yet if this applies to CBD.
Currently, the U.S. Food and Drug Administration (FDA) does not regulate the safety and purity of CBD products, so you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. The product may contain other unknown elements. The most effective therapeutic dose of CBD for any particular medical condition has not been established.
Are CBD Products Legal?
CBD products derived from hemp are no longer considered schedule I drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone. There are changes underway on federal and state levels that will ultimately clarify the laws and regulations related to CBD-based products and sales. Despite that, they’re widely available in nearly every state and online. People who want to use CBD should check their own state laws.
Studies have found moderate interactions between common RA drugs and CBD. Discuss with your doctor before starting CBD if you take these medications:
CBD tan increase the level the blood thinner coumadin in your blood. It can also raise levels of other medications in your blood by the exact same mechanism that grapefruit juice does.
Medications that this kind of reaction with grapefruit juice and potentially CBD include:
- Cholesterol medications
- High blood pressure medications
- Organ-rejection medications
- Anti-anxiety medications
- Heart medications
- Some antihistamines
Preparation and Dosage
If you’ve decided to try CBD for your RA pain, the next step is figuring out how much to take. Your dosage depends on a number of factors:
- Body weight
- Condition you’re treating
- Body chemistry
- Concentration of the CBD and the form of CBD you’re taking
You will likely need to start small and find what works for you. Studies have found extreme differences in dosages with some people using 5 mg and others as much as 600 mg.
If you’re unable to get guidance from an expert or your health care provider, start with 20-40 mg per day and increase slowly each day until you feel the relief you’re looking for. Again, this is different for everyone. Studies have found that CBD is safe at doses as high as 1,500 mg per day.
To ensure that you are using CBD safely and effectively for pain management, you should:
- Choose an oral treatment (rather than inhaled products) and start with a low dose taken in the evening
- Establish initial goals of treatment within a realistic period of time. For example, a reduction in knee pain that allows you to walk around the block within two weeks of starting treatment; later, if improved, the goals can be adjusted
- Tell your doctor(s) about your planned and current CBD treatment; monitor your pain and adjust medications with your medical providers, rather than with non-medical practitioners
- When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose
If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, talk to your doctor about taking CBD with a very low-dose THC product. Be aware that THC, even at low levels, may get you high, creating cognitive, motor, and balance issues.
If you experience any unwanted side effects when using a CBD product, immediately discontinue use and inform your doctor.
What To Look For
Look for the following when choosing a CBD product:
- Look for products manufactured in the United States with ingredients grown domestically
- Choose products made by companies that follow good manufacturing practices established by the FDA for pharmaceuticals or dietary supplements or required by the state where they are manufactured
- Buy from companies that test each batch and provide a certificate of analysis from an independent lab that uses validated standardized testing methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP), or the Association of Official Agricultural Chemists (AOAC)
- Avoid companies that claim their products have disease benefits
- Be aware that marketers and people behind retail counters are not health professionals. Your doctor is your best source for guidance and monitoring when using an unregulated product
A Word From Verywell
CBD may sound like an appealing option for pain relief, but do your due diligence before jumping on the bandwagon. A lot of people say CBD can help reduce pain and inflammation for those with RA, but not a lot of strong scientific data have substantiated that claim. That said, no serious effects have been reported with CBD use.
If this is something you are interested in, you can work with your doctor to figure out whether CBD is something you can try safely. Remember that CBD should not be used as first-line treatment for RA pain, and that it’s not advisable to stop taking disease-modifying treatments for RA.