CBD: what is the benefit in the treatment of spondyloarthritis?

What is spondyloarthritis?

Also known as spondyloarthritis, spondyloarthropathy and rheumatic pelvispondylitis, spondyloarthritis is a chronic inflammatory disease that affects the points where muscles or ligaments attach to the bones (the entheses). It concerns around 300,000 people in France, i.e. 0.3% of the population, with a prevalence that seems homogeneous between women and men. When the disease is concentrated in the region of the pelvis (sacroiliac and hips), then it is called ankylosing spondylitis.

According to the latest research, the disease is linked to a genetic predisposition, with the presence of the HLA B27 antigen. This is what would explain the relatively common family forms.

Insofar as the painful symptoms have an inflammatory origin, cannabidiol (CBD) is considered to improve the quality of life of patients on a daily basis. Remember that the molecule is known for its analgesic (painkiller) and anti-inflammatory properties.

Contrary to what one might think, spondyloarthritis has nothing to do with osteoarthritis or degenerative rheumatism in the elderly. It is a slow, even very slow, autoimmune disease that is not life-threatening but can lead to disability. In the vast majority of cases, spondyloarthritis begins with mild to moderate pain in the lower back or in the buttocks. Over time, they radiate to the thighs and mimic sciatic pain.

Pain in the joints of the legs and arms occurs in 60% of cases. The Achilles tendon, the joints of the thorax (connecting the ribs to the sternum) and the vertebrae of the back and neck are also affected. Finally, it should be noted that spondyloarthritis can eventually manifest itself in non-articular symptoms:

• In 20% of cases, spondyloarthritis is accompanied by inflammation of the eye, or uveitis. The eye becomes red and painful. This is an ophthalmological emergency.
• In 15% of cases, spondyloarthritis is accompanied by psoriasis;
• More rarely, spondyloarthritis may be accompanied by chronic inflammatory bowel disease (Crohn's disease), respiratory failure, protein deposits in the kidneys or inflammation of the urethra in men and the cervix in women.

Spondyloarthritis: what is the point of CBD?

Patients who suffer from spondyloarthritis generally benefit from drug treatment based on nonsteroidal anti-inflammatory drugs and analgesic drugs to limit flare-ups. Basic treatments can be prescribed if the disease progresses, generally with biomedicines (anti-TNF agents, interleukin inhibitors, etc.). What about CBD?

This molecule extracted from hemp, mainly from the Cannabis L. Sativa, Cannabis Indica varieties or a mixture of the two, has aroused the interest of the scientific community. Its analgesic, anti-inflammatory and soothing properties can possibly complete the pharmacopoeia intended for the management of patients suffering from spondyloarthritis. Of course, the objective is not curative. It is essentially about improving the quality of life of patients by relieving pain, limiting joint stiffness and reducing inflammation.

CBD could eventually be a viable alternative to painkillers, including opioids that can cause stubborn addiction.

CBD and spondyloarthritis: literature review

Unfortunately, the scientific literature remains very poor when it comes to assessing the value of CBD in relieving the symptoms of spondyloarthritis and its so-called “ankylosing” form. Let’s start with the position of the Canadian Spondyloarthritis Association (CSA). The organization explains in this release that CBD appears to "help patients relieve symptoms like chronic pain, but no scientific studies have evaluated cannabis for ankylosing spondylitis”.

As part of an ongoing study, a multi-site randomized controlled trial attempts to evaluate the effectiveness of CBD in relieving the symptoms of ankylosing spondylitis and rheumatoid arthritis. This rigorous research work should shed new light on the place of CBD in the management of these inflammatory pathologies in the years to come.

Another study reported by Nature.com journal demonstrated that CBD significantly reduced inflammation in patients with rheumatoid arthritis , with an antiarthritic activity which is explained by the activation of synovial fibroblasts. Researchers speculate that this mechanism could recur in people with ankylosing spondylitis and other similar inflammatory disorders.

On a more empirical level, the American Arthritis Foundation has published some interesting figures on the perception of CBD as well as the motivations that lead consumers to use it:

• 94% of respondents said their main reason for using CBD was for pain relief;
• 77% report reduced stress and anxiety;
• 71% use CBD to improve sleep quality;
• 67% believe that CBD helps them improve their physical condition;
• 41% report a "general feeling of well-being" when taking CBD;
• 30% report relief from morning joint stiffness and mobility issues with CBD consumption.

“In general, complementary and alternative medicine (CAM) does not slow the progression of ankylosing spondylitis, but it can help treat symptoms. This is why it is important to continue taking the medications prescribed for spondyloarthritis, especially disease-modifying treatments, while experimenting with CAM […] in consultation with your rheumatologist” , explains the MySpondylitisTeam association. Finally, it should be noted that the major clinical experimentation on CBD and THC carried out by the French Ministry of Health since March 2021 does not relate to the management of spondyloarthritis and other inflammatory pathologies.