Outcomes Vary When Cannabis Is Used for Pain Management in Rheumatic Disease | ACR Convergence
Investigators evaluated the role that cannabis plays in pain management in different populations with rheumatic diseases.
Although treatment of rheumatoid arthritis has advanced, effective pain management remains a challenge.1 Previous research has shown that between 12% and 20% of rheumatology patients use cannabis to help manage pain symptoms.2 Cannabis is known for immunomodulary and analgesic effects, presenting a “promising” alternative to opioid therapies. But despite state-level legalization and increasing both medical and nonmedical access and use, there is limited data around cannabis use and its outcomes in this patient population.
Investigators evaluated the role that cannabis plays in pain management in different populations with rheumatic diseases. | Image credit: YARphotographer - stock.adobe.com
Two abstracts presented at ACR Convergence 2024 evaluated cannabis use for pain management in different populations of patients with rheumatic diseases.
Cannabis Use in Rheumatoid Arthritis
Using the National Inpatient Sample database, researchers conducted a retrospective, cross-sectional study outcomes in hospitalized patients with rheumatoid arthritis using cannabis. Data from 2016-2021 were used, and all adult patients with a rheumatoid arthritis diagnosis were included in the study.1
Within the cohort, patients with rheumatoid arthritis who used cannabis (n=42,415) were significantly younger and more likely to be men (mean age, 51.8 years; 73.71% men) compared with nonusers (n=3,304,869). Individuals who used cannabis were more likely to be Black and Native American, and less likely to be White; patients who used cannabis were also more likely to be in the lowest income quartile.
In terms of hospitalization outcomes, mortality was significantly lower in those who used cannabis (0.98% vs 2.71%), with those patients incurring lower total hospital costs ($57,773 vs $63,681), with no significant difference in the length of hospital stay noted.
After adjustments were made for gender, race, and comorbidities, cannabis use in rheumatoid arthritis was associated with a significant decrease in mortality, depression, chronic pain, and anxiety (ORs, -0.5, -0.47, -0.45, and -0.55, respectively). However, cannabis use was associated with an increased risk of opioid use, nicotine dependence, and alcohol use (ORs, 1.1, 1.35, and 1.35, respectively).
READ MORE: Exploring Cannabis Utilization in the Oncology Landscape
“More research is needed on the long-term effects of cannabis in [patients with rheumatoid arthritis,” the researchers concluded, “and the population at risk of dependency should be monitored closely.
Cannabis Use Behavior Across Rheumatologic Conditions
Within a cohort of rheumatology patients from California, investigators sought to determine if patient characteristics differ based on cannabis use patterns, as well as to identify the effect of cannabis on patient-reported pain scores in current cannabis users.2
A total of 2733 patients responded to an emailed survey that collected demographic information, numerical pain rating scale score, self-reported cannabis efficacy on joint and overall body pain, and other domains.
The cohort of respondents (73% women; 62% white; 74% college educated) included patients with rheumatoid arthritis (19%), osteoarthritis (10%), systemic lupus erythematosus (9%), and fibromyalgia (7%). A total of 26% of patients were never users, while 33% were former users, 19% were current non-medical users, 12% were current medical users, 11% were current medical and nonmedical users. Investigators noted differences in cannabis use across axe, sex, race and ethnicity, and employment status, with users of both medical and non-medical cannabis being the youngest at 43.5 years, current nonmedical users with the lowest proportion of women, and current medical users most likely to be white (70%) with the lowest rate of employment (52%).
The numeric pain rating scale score (mean 41.2) was significantly different across cannabis use groups. Individuals in the current medical user group reported the highest pain levels (51.5±25.9). Within the group of current cannabis users, 65% used for management of joint pain, while 49% used for management of overall body pain. Current medical users reported mean efficacy scores of 70.2 and 71.8 for joint and overall pain, respectively, with similar findings reported for current medical and nonmedical users.
“Approximately 23% of survey participants reported current use of cannabis for medical purposes,” the researchers concluded. “Current cannabis users reported higher pain scores and a cannabis effectiveness of [approximately] 70 for joint pain and overall body pain.”
Future studies should examine the impact of cannabis on pain treatment in rheumatology patients.
READ MORE: Nonopioid Pain Management Resource Center
References
Shrestha K, Subedi P, Ghimire 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 14-19, 2024; Washington, DC. Abstract 0466.
Hui M, Jackson N, Pham A, et al. Medical and nonmedical cannabis use by rheumatology patients: a study of over 2000 patients in California. Presented at: ACR Convergence 2024; November 14-19, 2024; Washington, DC. Abstract 1217.
