Study Finds Benefits and Risks in Cannabis Use for Rheumatoid Arthritis

New research on cannabis use has elucidated characteristics of people with rheumatoid arthritis (RA) using cannabis and found benefits on mortality, depression, chronic pain, and anxiety, but an increased risk of f opioid use, nicotine dependence, and alcohol use.¹

Data from a retrospective cross-sectional study were presented at the American College of Rheumatology (ACR) Convergence 2024, held November 15-19 in Washington, DC, by Karun Shrestha, MD, Internal Medicine Resident at St Barnabas Hospital and Research Fellow, Acute Care Research Consortium, Mayo Clinic.

“Despite advancements in RA treatment, effective pain management remains challenging, with many patients also experiencing insomnia, anxiety, and depression. As cannabis legalization grows across the globe, its use recreationally and medically is increasing. Cannabis, with its immunomodulatory and analgesic effects, offers a promising non-opioid alternative,” Shrestha and colleagues wrote.¹

Shrestha and colleagues conducted the cross-sectional study using data from the National Inpatient Sample (2016-2021). They used International Statistical Classification of Diseases (ICD-10) codes to identify primary and secondary diagnoses and included all adult patients with a diagnosis of RA. They compared the demographics, baseline clinical characteristics, comorbidities, and inpatient outcomes, including mortality, hospital length of stay, total hospital charges, in patients with or without cannabis use.

The investigators found that patients with RA using cannabis (n=42,415) were significantly younger (mean age 51.80 vs. 67.77 years) and had a lower proportion of females (60.65% vs. 73.71%) compared to non-users (n=3,304,869). People using cannabis were more likely to be Black (24.02% vs. 12.86%) and Native American (2.25% vs. 0.86%) and less likely to be White (63.52% vs. 74.13%). Cannabis users were also more commonly in the lowest income quartile (38.76% vs. 29.07%).¹

“The primary problem is that very few appropriately powered randomized controlled trials have been completed,” Daniel Clauw, MD, professor of anesthesiology, rheumatology and psychiatry, University of Michigan, who is giving a related presentation on cannabis as a therapy for chronic pain during the meeting, said in a statement.² “The older trials are generally with smoked cannabis and neuropathic pain, and it is often difficult to know how much THC and CBD these products contain. The only firm conclusion is that when used medicinally, cannabis appears to be safe.”

In terms of outcomes, the investigators found that mortality was significantly lower among cannabis users (0.98% vs. 2.71%), who also incurred lower total hospital charges ($57,773 vs. $63,681) than non-users. Shrestha and colleagues found no significant difference in the length of hospital stay.¹

“Cannabis is neither the evil weed from hell nor the best thing since sliced bread,” Clauw said.² “For chronic pain, it is almost certainly more effective and safer than opioids, mainly because opioids are so ineffective and dangerous when used for chronic pain.”

“More research is needed on the long-term effects of cannabis in RA patients and the population at risk of dependency should be monitored closely,” Shrestha and colleagues concluded.¹

REFERENCES

1. Shrestha K, Subed P, Ghimir M, et al. Inpatient Outcomes of Rheumatoid Arthritis in Hospitalized Patients Using Cannabis: Data from the National Inpatient Sample. Presented at: ACR Convergence 2024; November 15-19; Washington, DC. Abstract 0466

2. Research at ACR’s Annual Meeting Explores Medicinal Marijuana Use and Rheumatic Disease-Related Pain. News release. November 14, 2024.