Rheumatoid arthritis is an autoimmune disease where the body attacks the joints and the lining of the joints. As the lining of the joint starts to wear off, a patient will start feeling pain. As the disease progresses, it can attack and damage other organs too.There is really no cure for this disease, but we can manage the signs and symptoms of it.
Unmanaged RA can lead to even greater health problems, so it’s important to not ignore the signs and symptoms of the disease. I talk about the risk factors around it. Some factors can be managed or minimized, like obesity, but others, like gender, cannot be controlled for. Adequate rest and losing weight are just a few of the things we can do to manage the disease before resorting to pharmaceutical means.
Pain management is a huge part of rheumatoid arthritis because it is incurable and can cause tremendous discomfort to patients. Some of the side effects of pharmaceutical means of treating the disease can be quite uncomfortable or even deadly. For example, ulcers, bleeding, and cardiac problems are all potential side effects with common drugs used to treat RA. Of course, these do not even compare to the side effects of steroids, which can be more effective, but also come with much higher risks.
There are some promising studies about cannabinoids’ role in pain management, but of course, we need much larger scale studies that remove the possibility of the placebo effect in these studies. We think that cannabinoids’ side effects are much smaller than steroids, but again, more studies will need to be done to prove their efficacy.
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- How rheumatoid arthritis is different from osteoarthritis.
- The signs, symptoms, and risk factors of rheumatoid arthritis.
- Why we sometimes see cardiac issues in patients with RA.
- Medical cannabis is used for pain management more than any other condition.
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This show is for educational purposes and should not be taken for a doctor’s advice. Welcome to Let’s Talk About Medical Cannabis with Doctor O. A clinical pharmacist certified in medical cannabis. Every week, you’ll learn about alternative ways to improve your health and well-being, using the powers of healing botanicals.
Hey, guys, thank you for joining me today for the episode of Let’s Talk About Medical Cannabis with Dr. O. For those of you that just joining us for the first time, Dr. Lola Ohanba, a clinical pharmacist, certified in medical cannabis. Before we go on to this show, let me say thank you to our sponsor. This show is sponsored by WCI Health, the alternative health and wellness store. At WCI Health, we help people get and stay well using the healing powers of botanicals such as cannabinoids. For all your high-quality hemp derived CBD product, ead straight to our Web site, WCI-Health.com. At WCI-Health.om for all your CBD hemp derived product.
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On today’s show, we’re going to be talking about the role of cannabinoid in the management of rheumatoid arthritis. First of all, in our previous episode, we talk about the role of cannabinoids in the management of osteoarthritis. So on that show we talked about, we defined what osteoarthritis is. We talked about the pharmaceutics, traditional pharmaceutics that is used in the management of OA, that is osteoarthritis. Then we talk about how cannabinoids might be able to help in the relief of some of the signs of symptoms synonymous to OA.
So on today’s show, we’ll be looking in to the role of cannabinoid in the management of rheumatoid arthritis. Again, thank you so much for joining me. So glad you are here. So what is rheumatoid arthritis? What is really arthritis?
Arthritis is more of an inflammation, is an inflammatory condition. It could occur naturally, in form of pain, inflammation. So we have different forms of arthritis like we discussed in our previous episode on OA, osteoarthritis. For those of you that have yet to access that episode, you can have the opportunity to listen to that on Apple podcast, Spotify, or you can also check it out on our Web site on WCI-Health.com.
So basically when you talk about osteoarthritis, that osteo use basically means bone. So the inflammation that is going on in osteoarthritis is affecting the bone. But when we talk about rheumatoid arthritis, this is a chronic inflammatory condition. So I guess somebody will say, what is the difference between rheumatoid arthritis and osteoarthritis? In their rheumatoid arthritis, the body immune system is affecting itself. The body is attacking its own. So basically rheumatoid arthritis is an auto immune disease condition. So when we say auto immune condition, what does auto me auto simply means, your body, yourself, your immune system is attacking your body tissue. That’s what happens in the case of for rheumatoid arthritis.
So what happens is that your immune system begins to attack the joints and the lining of all the joints in our body.
So when the day meal systems start attacking these joints, the lining of the joints start wearing off and you start experiencing swelling and pain that is characteristic of arthritis, especially rheumatoid arthritis. Apart from the damage is done, due to the inflammation, other parts of the body are also affected when we are going through rheumatoid arthritis. That means your kidney can get affected, your lungs. So it’s not just the bone that is being affected, it’s also affects the other organs of the body. So this is a very, very serious condition. There is really no cure for this disease right now for this condition. But we can manage the signs, and symptoms that is associated with this disorder. So basically today, what we’re look at the signs and symptoms synonymous to this rheumatoid arthritis, which I’m going to call from time to time, RA. That is it’s a short form that we use for it. We’ll look at the signs and symptoms. We’ll look at the traditional pharmaceutics that is used in the management of this disorder.
Then we will also look at the role of cannabinoids. In what way can cannabis-based therapy help in the management of this disease? Even if it is not able to cure the disease, at least some of the signs and symptoms that is associated with the disease, we want to look and save if there’s a way cannabinoid-based therapy might help.
So what are the signs and symptoms of RA? RA’s symptoms normally manifest early in the form of pain in the joints of the fingers, toes, like all those smaller joints of our body. That’s where you’ll notice this first. So as time goes on, it begins to spread to the ankle, to the bigger bones’ joint, like the wrist, the hip bone, the elbow, the shoulder. It begins to spread to that part of the body. So as the disease progresses, it begins to affect the skin, the lungs, the bone and the bone marrow, kidney.
So it’s not just your bones. It also affects other parts of your organs. So what do we see? We see a swelling of the joints, that is warm. Sometimes when you touch people that are going through this disorder, you experience a warmness to the touch. There is a characteristic stiffness that is associated with the joint that is affected. And part of why this is is due to inability of the bone to move. Basically what’s happening, as the body is attacking the lining, the cartilage on this joint, what happens is that the cartilage on the line is surrounded the cartilage of what we call synovial fluid. The synovial fluid helps our joints and helps it to move around. Just like lubrication for the joint.
So this part of the body when our immune systems starts attacking the joint, basically what happens is that there is wearing and tearing of cartilage and the lining of synovial joint. So what happens in that situation is that the body, that part of the body is not able to move effectively. There is what we call inflammation and swelling.
This inflammation and swelling causes the joint to not be able to move as it should. So most of any time we see people manifest any form of loss of appetite because it makes sense. You know, when you are going through pain, you don’t wanna eat. There is loss of appetite.
And basically, as the disease progresses, it varies in severity. When it becomes really unbearable for some people, it’s called flaring up. When it flares up, that means it’s really, really unbearable for people. Then also like a kind of flip flop into a remission state. When we say the remission state, that means the swelling, the pain is less active at that particular time. So what are the risks factors? What are the risk factors for rheumatoid arthritis? One of the risk factor’s is genetics. I mean, it’s just what it is. We don’t really know what causes it as a genetic. It could be due to mutation.
When we talk about mutation, mutation can happen form of maybe environmental factors or change in the DNA in our body, for, you know, some people that works with asbestos, pollution, could cause genetic mutation. And also it’s seen that this disease is more common in female compared to the male population.
Also, obesity or overweight can cost problem for us when it comes to rheumatoid arthritis, because the excess weight that we have can put extra pressure on the joints that are affected. So these are some of the signs and symptoms.
So if this rheumatoid arthritis if it’s not managed, it can lead to other diseases such as osteoporosis. Osteoporosis, basically can mean loss of bone. It’s a loss or weakness of the bone. And that could lead to fractures of the bone. It can also result infection, because some of the medication that we use to manage this disorder like the steroids. What they do is they reduce our immune system. So when they reduce the immune system, this leaves us vulnerable to infection. And it will make sense because first of all, we are already dealing with immune system, attacking our join, then we are using medication like corticosteroid, let’s say prednisone, which have side effects that also causes bone loss and also sometimes suppresses our immune system.
So in this situation it’s like your immune system is being attacked in two phases. Because of that, this could lead to us being more susceptible to infection. It’s also a little situation where we call carpal tunnel syndrome. Carpal tunnel syndrome, and that would make sense because this rheumatoid arthritis affects the small finger, the wrist, the small joints of the body. So the nerves, when these small joints attack by the immune system, these also affect the nerves surrounding this small joint.
So when the nerves are messed up at the joint, then it can result in the carpal tunnel syndrome. Apart from carpal tunnel syndrome, we can also experience heart disease. Part of what we see where we fall in. People that have rheumatoid arthritis is what we call a rheumatoid nodule. These are mostly found around the joint. Basically, what happens is that as the immune system is being attacked, as the joint is being attacked by the immune system all these nodules that are breaking can aggregate. When they aggregate they can block the blood vessels. When they block the blood vessels, that means the blood is not able to flow, as it should to other parts of the body, especially the heart. So if the blood vessels, like the arteries and your veins, that are supposed to carry blood to and from your heart, the lung, other part of your body, if it is not able to flow due to these nodules blocking the flow, this can lead to heart attack because blood is not flowing effectively to the heart.
So it could also lead to stroke. So these are some of the reasons why we see cardiac issue in some people that have rheumatoid arthritis. Apart from cardiac issue, the other condition that can be seen is in cancer such as lymphoma. There are studies have shown that in a patient with rheumatoid arthritis, there’s an increasing risk of lymphoma. This is a form of cancer that has the lymphatic version. In our lymph nodes, all these as a result of infection. If our lymph is infected, this could result in lymphoma.
So what are the ways that we could prevent or manage this disease? The non-pharmacological ways. When I say non pharmacological ways, I’m just saying what ways other than medication, other than traditional pharmaceutics that we can manage this disease. So the best way to manage in the beginning when we start noticing because we can’t cure this disease is there is no cure for it. We can only manage the symptoms. Other ways we can manage it without the drug is exercise, occupational physical therapy. This can help in the improvement of the joints movement.
The mobility of the joint through physical and occupational therapy that can help with that. Other than that, we need to have adequate rest. Those things that we have to do to help us to sleep. And also for people, for patients that have a weight condition,we can also try to lose a little bit of weight. That will take a lot of pressure from the joints. Apart from this process, all the ways that people can manage, but that will come after we have tried pharmaceutical therapy and is not working. That will be in surgery. People can do tendon repair or joint replacement or what they call Tenos novia surgery. Basically, surgery can be used to help. It either replaces the knee or replaces the cartilage or do something with these sinovia fluid to help.
Basicallywhen we do all this, what we are trying to target is the pain because does the most important part of what we are going through. When we go through this disease, it’s characteristic with serious pain. So apart from non-pharmacological ways, what other ways are we able to manage this rheumatoid arthritis? Medication and drug depends on the severity and duration of the disease. Basically what that means is the kind of medication of Madison we’re going to choose would depend on how long this patient is been going through this disease and the severity of it. So for the first line of therapy, the first line are what we call an inflammatory drugs, because inflammation and pain are the main signs and symptoms, they are the main side effects that we see from this disease.
So the first line of therapy is what we call NSAIDS. NSAIDS are non-steroidalanti-inflammatorydrugs. The nonsteroidal anti-inflammatory drugs, what do they do? They help with inflammations. Nonsteroidal anti-inflammatory, just as in the name. They are not steroids. That’s why we say they are non-steroid. So they help with inflammation. Examples of those kind of drugs are your ibuprofen, your Motrin, your Advil, your Aleve. They help with that. But we also have the selective agent like the Celebrex. Those are selectable. What are the side effects of the nonsteroidal anti-inflammatory drug?
The side effect that we see in the nonsteroidal Anti-inflammatory like your ibuprofen is the potential for stomach ulcer, and especially in the elderly population it could result in bleeding. Or in some agent like the Celebrex, we have to watch out for signs and symptoms for cardiac. For people that have cardiac issues like heart disease, we have to watch out for that.
One of the other ways that we use this product NSAIDS is that sometimes we combine it with what we call PPI, proton pump inhibitors. These are like the Omeprazole or your Pantoprazole or Nexium. Those are the common names that you will notice for. Basically what those do is they help to protect the stomach lining to prevent the ulcer or the bleeding.
So other than the NSAIDS, what are the other main drugs that we use? The other main drugs that we use are the steroids. The steroids are the big guns when it comes to inflammation. And we have an example of those, Demerol, your prednisone, the hydrocortisone. But the steroid injections are way more effective when we are talking about steroid, but they have higher side effects. There’s a lot of side effect that we see when we use steroids. Examples of the side effects that we see are the bone loss. And that’s a problem, especially in the elderly population. If we already have a rheumatoid arthritis that’s already affecting our joints and our bones and there is a medication that is also going to cause bone loss.
So that will be kind of problematic. Steroids do work for a lot of patients but at the same time, we do not want to use these for a long time. Some of the other side effect that we see is weight gain. And it’s kind of like counter intuitive in a way, because some of the thing we’re trying to get rid of when we are dealing with rheumatoid arthritis causes weight. That excess weight puts extra pressure on the joints. So if we are using a drug that is also going to get us to gain weight, that can be a problem. And a lot of patient, might not even want to be compliant or even use their medication.
Steroid can also cause aggressive behavior or metabolic syndrome such as diabetes. So all this are what we have to look out for. For the severe diseases where the main drugs that are used are what we called disease modifying anti-rheumatic drugs. We call them DMARDS. DMARDS are the disease modifying anti-rheumatic drugs. Basically once you bring that in within around the first three months. Most of the health care providers will bring in DMARDS. And studies are showing the early use of the DMARDS can resort in a more favorable outcome and can also reduce the risk of death.
Some of the first line drugs in the families of the DMARDS are the methotrexate, hydroxychloroquine. I know we have heard a lot about that drug. We have heard a lot of the hydroxychloroquine. Well it’s actually FDA indicator for rheumatoid arthritis. And we also have drugs like a sulfasalazine. Those are some of the main drugs that we use. What are the side effects of the DMARDS? This could lead to liver damage for people with liver disease. We have to watch for bone marrow suppression and it could even lead to severe lung infection. And when we talk about methotrexate, we cannot use this in women of childbearing age, because of the potential for what we’ve got teratogenic effect. Basically what teratogenic means is that methotrexate can cause harm to unborn child or for a breastfeeding mother. You do not want your baby to have this thing in your breast milk.
So one has to watch out for that. It’s contraindicated in pregnant people. Other than the DMARDS, we also have the biological agents. The biological agent, these are called disease modifying agents, but they are kind of like demarches, but they are biologicals.
And some of them, they end in MABS. When you start here in MABS, then, you know, they are biological. The way I did when I was in school. Do I recognize these drugs? Is that when I see DNA, maybe at the end of. I know does the biological agent. So an example all those are Humira which is Adalimumab. And we have these Samzia which is Certolizumab and is SIMPONI. We also have rifizan which is right to some lab and we also have the Infliximab, which is called Remicade. Eiderdown demand is the order but biological the common ones idea orashia or the Embrian or Celgene.
I’m sure many of you would have seen the commercial on the TV. The biological agent targets the immune system that causes the inflammation resulting in the joint. Basically, what a biological agent does is target the immune system. Unlike the other agent that targeted the inflammation itself. These biological agents go straight to the source. And the biological agents are always gonna be more effective when you use them as a combo product. Like say you could use the biological agent with either the methotrexate or the Inset. They are kind of more effective.
What are the side effects of the biological agent? Of course, they are biological so you could cause the infection. It could result in the blood clot in some agent like Tosefini, some of the agents that result in a blood clot. So if we have tried pharmaceutics and we are not seeing resolved, what else can we do? In what way might cannabinoids be able to help?
Due to prohibition effectiveness of cannabinoid products, a lot of studies still need to be done. So most of the documentation of effectiveness that we have from anecdotal daughter away is word of mouth from people that use it. We have some studies, but it does distort some of them. Small studies that we are seeing shows the administration of cannabinoids extract over a few weeks’ period significantly reduces pain, reduces inflammation. It helps patient to sleep.
It reduces the intensity of the pain in rheumatoid arthritis patients compared to patients that we are given placebo. Basically when you see a placebo it means the product they give the other control does not have active ingredients in there.
It’s also been shown that CBD suppresses the progression of arthritis in experimental animals. and CBD also been shown to protect the joint against severe damage. And effectively block progression of arthritis after the onset or in clinical symptoms. So basically, studies have shown the CBD doesn’t just protect the joint after the rheumatoid arthritis is already swelling. Even during the clinical symptom, when you start having these symptoms and you start using CBDT based product it’s been shown to help.
According to some to the Journal of Neural Immunology cannabinoid could provide symptomatic relief of joint pain, swelling, suppression of joint destruction and disease progression and rheumatoid arthritis. So basically, in this study, they found out that cannabinoids helps in reducing disease progression, reduces the speed at which the disease was going on.
So another study that was done in 2003 apprise at all and he said it is a collie’s. They found that their cannabinoids reduce the damage to myelin sheath covering the nerve cell caused by inflammation. So when we talk about myelin sheath, these are nerves. These are neurons so they find out that the cannabinoid reduces the damage. When the myelin sheath is damaged, what it causes inflammation of the nerves. So Price and his colleagues find out was that cannabinoid was able to reduce the damage that is done to these neurons. And as such reduces inflammation.
Apart from that, one of the main symptoms that we see, one of the main problems with rheumatoid arthritis or any of these arthritis generally is pain. Pain is the number one medical condition that people use cannabinoids for. And rheumatoid arthritis is characterized by severe pain.
Inflammation, which cannabinoids have the potential to alleviate. THC has been shown to have up to 20 times anti-inflammatory properties compared to steroids such as prednisone. And what we were talking earlier in the therapeutics, pharmaceutics, we talked about using steroids, now this is the big gun that is used in the traditional pharmaceutics. But come to think of it, THC got 20 times the power that the steroid has. That is huge, people. That is absolutely huge. Oh, yeah, we have a steroid. Then we have THC based product that have 20 times. That’s a big deal. Apart from that, we have NSAIDS, non-steroidanti-inflammatory properties that are used as a first line. But, THC has 20 times the anti-inflammatory properties. And the side effect that you see from cannabinoid is not even in the same category as the side effect that you see in, say, like steroid that you have bone loss, you have aggression. You have infection. And you have in the case of NSAIDS, like ibuprofen, you have GI bleeding, which are not seen in product like THC.
So with this kind of documentation that has shown that cannabinoid might be able to help in the management of the side effect of this disease. So why are we not using this agent to manage this disorder? Or why are we not even trying to even look into this product and do our research? DMARDS, even the DMARDS that are the main target, they have side effects, as in infection and all kinds of stuff that we don’t know won’t see. And some of the side effect that has been recorded for cannabinoids, they are reversible. They are not a major side effect. Sometimes they are like those strengths.
So if you use, the higher you go, high dose can give you a specific effect, a lower dose can give you a specific effect. So you’ll have the ability to be able to tie straight up or down. So why are we not doing research? Why are we not looking into this situation? Well, my people, I guess we’ll have to leave the answer to that question. So the powers that be hopefully we will get into a situation whereby clinician, scientists and researchers can begin to actually do. I mean, there are a lot of studies right now, but we need large studies. We need funding to be able to actually have full documentation of the powers of cannabinoid-based product.
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So other than that, thank you so much for hanging out on our show. We’re going to be looking into gout. Gout is an autoimmune disorder, too, so we will be looking into gout. So you do not, absolutely don’t want to miss that. Until next time. Please be safe. Wear your mask. Social distancing. And remember health equals wealth. Bye, guys. See you. Thank you guys so much.