Are Cannabis, Cannabis-Derived Products, and Synthetic Cannabinoids a Therapeutic Tool for Rheumatoid Arthritis? A Friendly Summary of the Body of Evidence.

Schulze-Schiappacasse et al. ·Journal of clinical rheumatology Impact 1.0

Mixed GRADE High 5 citations

Samplek = 26 Studien

Durationunclear

ControlPlacebo

EndpointDisease activity

Blindingunklar

DesignSystematic Review

Key finding

Cannabis products may slightly reduce disease activity, but show little to no difference in pain reduction and may increase nervous system adverse events; evidence for serious adverse events very uncertain.

Summary

Umbrella review of k=26 systematic reviews, which together identified only 1 RCT on cannabis/cannabinoids in rheumatoid arthritis. Cannabis/cannabinoids may slightly reduce disease activity; show little difference in pain reduction; may slightly increase nervous system side effects. Evidence on serious adverse events very uncertain (GRADE: very low quality).

PopulationAdults with rheumatoid arthritis (RA)

InterventionCannabis, cannabis-based products and synthetic cannabinoids

ControlPlacebo

OutcomePossibly slight reduction in disease activity; little difference in pain reduction; slightly increased nervous system side effects; very uncertain evidence on serious adverse events

Confidence in the evidence

High

The highest of four GRADE levels, the effect estimate is very reliable.

Quality profile

Sample size ★★★★★

Blinding —

Effect size Mixed

Citations / year ★★★★★

Authors

Schulze-Schiappacasse C, Duran J, Bravo-Jeria R, Verdugo-Paiva F, Morel M, Rada G

DOI 10.1097/rhu.0000000000001745↗

Design: Systematic Review

Abstract

Background: Symptom management in rheumatoid arthritis (RA) remains a complex challenge. Widespread use of cannabis-based medicines for a myriad of symptoms has fostered rheumatology patients' interest. However, their safety and efficacy in RA remain unclear. Objective: The aim of this study was to perform a structured summary of the body of evidence in order to determine whether cannabis, cannabis-derived products, and synthetic cannabinoids are an effective treatment for rheumatoid arthritis. Methods: An electronic search in Epistemonikos database was performed to identify systematic reviews and their primary studies that addressed our clinical question. The body of evidence was collected in a pivot table in Epistemonikos. Information and data from the primary studies were extracted from the identified reviews. Finally, extracted data were reanalyzed, and a summary of findings table was generated using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: Twenty-six systematic reviews were identified which included in total only 1 randomized trial assessing our clinical question. Conclusions: Cannabis, cannabis-derived products and synthetic cannabinoids may slightly reduce disease activity in patients with RA. Its use may result in little to no difference in pain reduction and may slightly increase nervous system adverse events. The evidence is very uncertain about the effect of cannabis, cannabis-derived products, and synthetic cannabinoids on serious adverse events risk.

The impediment to action advances action. — Marcus Aurelius