9 tips for sleeping better with arthritis

From restless.co.uk/health

Arthritis causes sore joints, which can make it difficult to get good-quality sleep. In fact, research suggests that as many as 80% of people with arthritis have trouble falling and/or staying asleep.

However, while sleep is a common source of frustration among those with arthritis, several things may help to improve your chances of getting more restorative sleep.

With this in mind, we’ve pulled together nine tips for sleeping better with arthritis. We hope you find them useful.

What’s the link between arthritis and sleep?

Arthritis can make it tricky to get good quality sleep due to the pain and discomfort the condition causes. Some people struggle to find a comfortable sleeping position, while others find they’re woken up by bouts of joint pain.

Not only can this be frustrating, but getting enough sleep is also essential for health – particularly when managing long-term health conditions like arthritis. This is because body tissue grows and repairs during sleep, and our immune system strengthens.

Experts have revealed that the relationship between arthritis pain and poor sleep works both ways – just as arthritis pain can disrupt sleep, a lack of sleep can increase pain and impact the body’s ability to heal itself. So, it can be easy to find yourself in an unpleasant cycle.

This study found that sleep loss intensified pain in patients with rheumatoid arthritis. Perhaps unsurprisingly, research has also revealed that those with arthritis pain who have trouble sleeping are more likely to experience depression.

Therefore, it’s important to find ways to overcome the difficulties of sleeping with arthritis to better manage the condition, while looking after your overall health and mental wellbeing as much as possible.

9 tips for sleeping better with arthritis

Now that we’ve explored the link between arthritis and sleep, here are some possible ways to increase your chances of getting more restorative rest…

1. Invest in a good-quality mattress

One of the best things you can do to improve your sleep is to invest in a good quality mattress.

According to experts, if your mattress is too firm, it can place pressure on your back and neck, and lead to spine misalignment. Similarly, if a mattress is so soft that your body sinks into it, this can negatively affect posture and aggravate arthritis symptoms.

How old your mattress is can also play a role; worn-out springs are often unable to provide your body with the support it needs.

In this study, 59 people were asked to sleep on their old mattresses for one month, before sleeping on a new mattress the following month. During the second month, participants’ stress levels dropped significantly, which experts put down to a reduction in back pain caused by the old mattress.

For more information on what to look out for when it comes to your mattress, check out our article: 9 ways your mattress can affect health and how to choose the right mattress for you.

2. Find a comfortable sleeping position

A good sleeping position supports the natural curvature of your spine – from your hips to your head. That said, what feels most comfortable for you will largely depend on which parts of your body are affected by arthritis pain.

For example, some people with arthritis of the knee find it beneficial to sleep on their back with a pillow placed beneath their knees; and for arthritis of the hip, it’s generally best to avoid sleeping sideways on the painful hip.

For more information on the pros and cons of different sleeping positions, check out our article: What are the best and worst sleeping positions? The Arthritis Foundation also offers specific advice on the best sleeping positions for different areas of arthritis.

3. Stay active

It’s normal to feel apprehensive about exercise if you have arthritis due to the fear that it could exacerbate joint pain. But research has consistently shown that staying active is one of the best things you can do for your joints.

While high-impact exercise like running and high-intensity interval training may place unnecessary stress on your joints, low-impact activities such as walking, yoga, Pilates, and Tai Chi can improve arthritis symptoms.

For example, this study found that exercise reduced joint pain, morning stiffness, and fatigue in people with rheumatoid arthritis. Other research has found that people with arthritis who exercise regularly have improved sleep patterns, more energy, and better day-to-day functioning.

For ideas on how to add more exercise to your routine, you might be interested in our articles: 15 low-impact exercise ideas and 7 low-impact exercises you can do at home. Or, why not tune into one of the upcoming fitness classes on Rest Less Events?

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For more information on the relationship between exercise and bone health, check out the ROS website.

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4. Consider using heat therapy before bed

Applying a heated compress is one of the oldest, cheapest, and most popular methods for relieving joint pain – and research has shown that heat treatments can be effective at relaxing stiff joints.

This is because when you warm up a sore joint or muscle, blood vessels in the area get bigger. Not only does this improve the delivery of nutrients and oxygen to the area, but the improvement in circulation is also effective at relaxing joints.

As a result, some people find that easing a painful joint with a heating pad for around 15-20 minutes before bed helps them sleep better. Amazon* has a good range of arthritis heat pads available to browse. Alternatively, a soothing bath has a similar effect.

Remember to allow your body time to cool down afterwards because it can be tricky to fall asleep when you’re too warm.

5. Find the right pillow for you

Making sure that your head and neck are in a comfortable, well-supported position is key to getting good sleep – and can also determine how your neck feels the following day. According to experts, the ideal pillow should fill the space between your ear and the mattress.

When lying on your back, it’s important to choose a pillow that supports your neck without tilting your head too far forward. If you’re a side sleeper, the pillow should support your head to be in line with your neck without tilting it too much up or down.

Some people who suffer from neck pain find that using extra pillows to support their arms at night makes sleeping more comfortable, and others prefer feather pillows – as these tend to be easier to mould into shape. That said, everyone’s different, so it’s important to find what works for you.

For more guidance, you might find our article, 7 tips to help you choose the right pillow, useful. Or, for more arthritis-specific advice, Health and Care’s article on best arthritis pillows covers a variety of suitable options for both side and back sleepers.

6. Establish a bedtime routine

The circadian rhythm is the body’s internal clock that, when properly aligned, helps to regulate sleeping patterns.

Establishing an effective bedtime routine can play a significant role in regulating your circadian rhythm. This is because our brains become attuned to recognising patterns and behaviours that signal when it’s time to sleep – for example, journaling, meditating, and winding down for bed away from electronics.

Bedtime routines have also been found to play a key role in reducing nighttime stress and anxiety that, when left unchecked, have been linked with an increased likelihood of insomnia.

You’ll find plenty of tips for establishing an effective nighttime routine in our article: How to design the perfect bedroom for sleep. Or, if you’d like to learn more about how your internal body clock works, check out our article: Everything you need to know about melatonin and the circadian rhythm.

7. Avoid caffeine and alcohol close to bedtime

Whether you have arthritis or not, general health advice warns that caffeine and alcohol can have negative impacts on sleep.

Caffeine is a stimulant, so having too much of it or drinking it too close to bedtime can make it more difficult to fall asleep. Studies have also found that it can throw the circadian rhythm out of sync. So, if you’re a coffee drinker, it’s worth experimenting with a cut-off point during the day – for example, 3pm – to see if it improves your sleep. In addition, experts recommend drinking no more than four or five cups of brewed coffee per day.

Similarly, studies show that while drinking large amounts of alcohol before bed may cause people to fall asleep faster, it also increases the likelihood of poor sleep quality and disruption. There’s a reason why you often wake up feeling groggy after a drink!

So, it can be helpful to limit your alcohol intake – particularly before bed. And, in cases where sleep quality is particularly poor, it might be worth eliminating it from your diet.

8. Take steps to manage stress

There’s a strong link between stress and arthritis. Research shows that the more stressed you are, the higher levels of inflammation in the body. Stress can also cause muscles to tense up, which can compound joint pain further.

As a result, taking steps to manage your stress levels can make a world of difference to arthritis pain and sleep quality. This might mean practising deep breathing, exploring ways to connect with nature, or using distraction techniques.

For more ideas, you might like to read our articles: 7 tips for coping with stress and anxiety and 9 simple stress relieving activities.

9. Experiment with arthritis pain-relief products

Alongside lifestyle changes like establishing a nighttime routine and limiting coffee and alcohol intake, there are also several products that are designed to ease arthritis pain and discomfort that may help you sleep better.

For example, some people with arthritis of the hand find that arthritis gloves help to manage pain. These work by applying gentle pressure to the hands to increase blood flow and hand temperature, which can help with discomfort. Arthritis gloves are available to buy on Amazon*.

Adjustable beds are another option to consider. These can be highly effective for relieving arthritis pain because they evenly distribute body weight and improve blood flow. While these can be expensive, many people find them worth it. For more information, you might like to have a read of these four surprising ways adjustable beds can relieve arthritis from Willowbrook.

You may also find our article on the potential benefits of CBD oil interesting. Some studies have suggested that CBD oil may offer anti-inflammatory and pain-relieving properties that could benefit people with arthritis. However, further research is needed to confirm these findings.

Final thoughts…

Arthritis can be uncomfortable, painful, and frustrating to live with, particularly when it gets in the way of sleep. However, while there’s no magic solution, we hope some of these ideas will help you get better, more restorative rest.

For further reading, head over to our sleep and fatigue and general health sections. Here, you’ll find content on everything from insomnia and bone health to diet tips for healthy joints.

https://restless.co.uk/health/healthy-body/tips-for-sleeping-better-with-arthritis/?contact_id=5e74dd65-8bd7-48a2-a626-ded9a62b692b&utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_email_25-04-06_general&utm_content=newsletter_email_25-04-06_general 

Study uses body’s clock to deliver medication precisely when needed

From source.washu.edu

Researchers at WashU Medicine have harnessed the internal circadian clock of the body to deliver medication for an inflammatory illness precisely when it was most needed. Tissue implants incorporating genetically engineered stem cells automatically delivered anti-inflammatory medications to mouse models of rheumatoid arthritis on a daily basis right before inflammation peaked. The researchers dubbed this approach “chronogenetics.” 

The research was published Feb. 7 in Nature Communications.  

Inflammatory flares in rheumatoid arthritis are triggered by changes in the levels of infection-fighting proteins in the body. The levels of these proteins fluctuate over the course of the day, as dictated by circadian signals driven by our normal 24-hour light-dark cycle. A team led by Farshid Guilak, the Mildred B. Simon Research Professor of Orthopaedic Surgery at WashU Medicine, developed a specialized stem cell implant that carried a synthetic gene circuit that was programmed to activate and release anti-inflammatory medication when the circadian signal turned on.  

The therapeutic implants, which consisted of the reprogrammed stem cells engineered into cartilage constructs, effectively treated inflammatory flare-ups for up to a month in mice. The implanted gene switches were adaptable as well: when the mice’s sleep schedule was reversed from sleeping during the day to sleeping at night, the cells rapidly resynchronized to the new circadian pattern.  

In humans with rheumatoid arthritis, painful inflammation triggered by the body’s daily rhythms might occur at 3 a.m., making it very difficult for patients to treat their symptoms effectively. If successfully adapted for humans, the chronogenetic approach could treat rheumatoid arthritis at the optimal circadian moment. Guilak and his team have received funding from Advanced Research Projects Agency for Health (ARPA-H) to develop this approach for clinical trials in human patients. Guilak has applied for a patent for the technique developed in this study. He is an also an employee and shareholder in Cytex Therapeutics Inc., which is developing the cartilage-based structures used in this study for therapeutic use.

https://source.washu.edu/2025/04/study-uses-bodys-clock-to-deliver-medication-precisely-when-needed/ 

Scientists urge earlier diagnosis and treatment of psoriatic arthritis to prevent permanent damage

From bath.ac.uk 

New research from the University of Bath reveals delayed diagnosis and undertreatment of psoriatic arthritis often results in irreversible damage to joints

Delays in diagnosing and treating psoriatic arthritis – a common inflammatory disorder affecting around 200,000 people in the UK – are causing irreparable damage to people’s health. This damage could be avoided by catching the condition earlier and treating it effectively, according to research led by scientists in the Department of Life Sciences at the University of Bath.

The new study, published today in the Annals of the Rheumatic Diseases, evaluated exactly where diagnostic delays are occurring and the treatments people are receiving. The results confirm a suspicion long held by the authors: that early symptoms of psoriatic arthritis (PsA) often persist for some time before the condition is diagnosed and treated.

The researchers are calling for improved diagnostic systems to be established, where people with PsA and the doctors treating them are supported to recognise the initial phases and diagnostic scans are offered earlier. A prompt response can prevent joint damage, and reduce pain and inflammation, resulting in far better physical function and quality of life for most patients.

The study was led by Dr William Tillett, researcher at the University of Bath and a consultant rheumatologist at the Royal National Hospital for Rheumatic Diseases (RNHRD), which is based at the Royal United Hospitals trust in Bath. He said: “Work from our group and other researchers shows that delays to diagnosis of just six months can result in worse physical function for a patient in ten years’ time, so diagnosing and treating the disease early, to prevent structural damage and preserve function, is vitally important.”

He added: “This disease can have a massive impact on people’s lives and make it difficult for them to work and manage regular daily activities.”

                                                        Delays in diagnosing psoriatic arthritis can result in irreversible damage to joints

Visible signs of PsA appear months or even years before a person develops the full-blown condition, generally giving clinicians plenty of time to intervene with appropriate treatment. However, signs are variable and can include the rash of psoriasis, joint stiffness, lower back pain, fatigue, swollen fingers and toes, and changes to the quality of finger- and toenails. These signs can easily be confused for less serious chronic conditions, leading to misdiagnoses. As a result, valuable time is often lost before a patient is referred to a specialist, leading to delays in the diagnosis and treatment of PsA.

Elaborating, Dr Tillett said: “With rheumatoid arthritis (another common arthritis), symptoms are quickly visible, so the condition is generally diagnosed without too much delay. It’s harder to detect inflammation in the joints affected by psoriatic arthritis, as these joints – such as those in the spine – are often not visible to the eye, and it takes an ultrasound to see the damage. Too often, scans don’t happen for some time after the patient starts noticing symptoms.”

For the new study, funded by Janssen Pharmaceuticals, the authors collaborated with the British Society of Rheumatology and National Early Inflammatory Arthritis Audit to evaluate people who were diagnosed with PsA between May 2018 and October 2019, and explore why there were delays in diagnosis.

The reasons were found to be multiple: people are slow to present to their GP with symptoms and once patients find their way to a specialist, there is a long wait before diagnostic tests are carried out. The reasons for the delays between seeing a specialist and undergoing a scan remain unclear. The researchers plan to investigate this issue further in future studies.

The research team believes screening people at high risk of developing psoriatic arthritis along with more streamlined diagnostic facilities are essential interventions to stop the occurrence of irreversible damage.

Dr Rachel Charlton, the study’s first author and a life sciences researcher at Bath, said: “We need more education around clinicians assessing people with arthritic symptoms and better access to scans. We also need to focus on early intensive treatment before damage sets in – there is a window of opportunity that we may be missing at the moment.”

In future work, the researchers plan to probe the experiences of patients and clinicians in the face of PsA, to develop a fuller picture of the reasons behind diagnostic delays.

https://www.bath.ac.uk/announcements/scientists-urge-earlier-diagnosis-and-treatment-of-psoriatic-arthritis-to-prevent-permanent-damage/

Can Cannabis Help Arthritis? (Podcast)

From arthritis.org/liveyes/podcast

More people are trying or considering using medical cannabis to relieve their arthritis pain. But what evidence is there to show us how effective and safe it is? A rheumatologist and expert on cannabis explains what is and isn’t known and offers some advice for people who want to try it 

Trina Wilcox: Welcome back to the Live Yes With Arthritis podcast. I am your host for this episode. My name is Trina Wilcox. I was diagnosed with juvenile rheumatoid arthritis, as they called it, when I was 6 years old. And as we grow up with a chronic condition, we deal with so many different things, and pain is among many. So, the topic for today — I am excited to talk to you so you can be as educated as possible about it — we are talking about medical cannabis for arthritis.

People have been turning to cannabis as it's more legal widely available throughout the U.S. But it's still difficult to get research on it. We don't know much about the safety-ness, the effectiveness, for arthritis. So, today I'm glad to introduce Dr. Mary Ann Fitzcharles, a rheumatologist and pain researcher at McGill University in Montreal, Canada. Thank you so much for being here. I'm glad that we have you to talk about what is and what isn't known about CBD and other forms of medical cannabis for arthritis. 

Dr. Mary Ann Fitzcharles: Good afternoon, Trina, and everyone. It's a real pleasure to be with you today. And hopefully I'll be able to share a little bit of insight that we have about medical cannabis in the management of our patients with rheumatic conditions. 

Trina Wilcox: Absolutely. Dr. Fitzcharles, you're well known for your research in medical cannabis and working with arthritis. Tell me a little bit about how you got into the area and your expertise in arthritis and such. 

Dr. Mary Ann Fitzcharles: Well, I think we all know that in the last number of years, probably in the last two decades, there've been amazing advances in the management of inflammatory arthritis. So, we have all of these beautiful disease-modifying agents, we've got all the biologic agents, and they're absolutely wonderful. However, even when patients are beautifully managed and their disease is, by our standards, well controlled, pain persists. 

Trina Wilcox: Yeah. 

Dr. Mary Ann Fitzcharles: And pain has a huge impact upon well-being, quality of life. If you have pain, you have difficulty sleeping. If you have pain, you might be anxious. Pain actually causes you not to think clearly. You're just not quite as sparky as you should be. So, pain is really a very, very important, persistent symptom in all patients with arthritis, be it inflammatory or, the old-fashioned word was degenerative, osteoarthritis. 

And the second component is that our medications for pain are really and truly not great. They either cause side effects, many side effects, either impact upon the kidneys, tummy upsets, cognitive changes, and they really are just not wonderful. With all the modern world developments, we have very few new medications to treat pain. I think this is one of the reasons why our patients are turning to medical cannabis. And asking: Is this not perhaps a reasonable treatment option? 

Trina Wilcox: Absolutely. So, let's start with the basics. I know that there are a lot of words that are used interchangeably but may not necessarily be synonyms. Can you kind of describe the difference between CBD and medical cannabis? 

Dr. Mary Ann Fitzcharles: OK. So, let's take two steps back, and we'll go back to a botany class. 

Trina Wilcox: OK. (laughs) 

Dr. Mary Ann Fitzcharles: Cannabinoids are a whole group. They're a whole soup of different molecules. And when you take the cannabis plant, which is cannabis sativa, and there's cannabis indica, so there are number of genuses of this plant. There are many, many molecules within the plant, and they're probably… Cannabis has been called the plant of a thousand molecules. So, within this plant, there are two molecules that have been of great interest and that have really been studied, and that is cannabidiol, which we call CBD. And THC: tetrahydrocannabinol. 

So, these are the two agents that we have studied a lot in the basic science world. And we do know that THC is the agent that has psychoactive properties. Psychoactive properties are the ones that sort of make you feel a little high, maybe a little sleepy. Whereas CBD, cannabidiol, also a cannabinoid, has almost no psychoactive properties. So, that's the difference in the two. And that's probably one of the reasons why initially people were very, very interested in the effect of CBD, because CBD supposedly is an agent that maybe has some good effect on pain, sleep, mood, but without causing the psychoactive effects. 

Trina Wilcox: OK. So now that we know a little more about the CBD, what evidence is there for its use, especially those of us affected by arthritis? 

Dr. Mary Ann Fitzcharles: So, we'll take another few steps back and say that really the use of cannabinoids, the use of CBD, has really run away with us. The researchers have been left in the slipstream. The reason is that we've not really been able to study these products as we normally do for other drugs. And the reason for this is that it's been very difficult to get products that have been adequately tested and regulated and allowed to be used in clinical studies. 

So, a lot of our information about cannabinoids comes not from standard randomized controlled trials, but come from cohort studies and come from what patients are telling us. We have a lot of cohort studies of cannabinoids, CBD, indicating to us that patients are using the agent, are reporting the effects of the agent, but we do not have much gold standard evidence. And the gold standard evidence is randomized controlled trials. 

Trina Wilcox: What can we do as advocates to get that done? 

Dr. Mary Ann Fitzcharles: It's slowly moving ahead, there is no question. But the difficulty is when you are dealing with a plant product, and as I said, this is a plant with a thousand molecules. Do you take out just one molecule and test the one molecule? Or is it a combination of the molecules that seems to be effective? What is that magic mix? 

Trina Wilcox: I see. 

Dr. Mary Ann Fitzcharles: So, that's the first thing. Because of recreational cannabis availability in many jurisdictions, unfortunately the pharmaceutical industry has not been terribly supportive of the medical stream. The recreational stream has gone ahead on its own, and it is taking a lot of effort and a lot of convincing to get the pharmaceutical industries or the cannabis producers on board. 

Trina Wilcox: OK. Well, is it effective for other conditions? Those of us that might have other problems, you know: secondary issues with sleep or something; or all those comorbidities that come along with a chronic condition. 

Dr. Mary Ann Fitzcharles: And this is what we hear from patients, and this is what we hear from cohort studies and observational studies: People say that cannabinoids, and again, it's very difficult to know what are people using… Are they using sort of something that they've bought off the street, which they do certainly in Montreal in Canada. And they really have no idea what's in the product? But generally, people are saying that the cannabinoids have the best effect on pain. But many people say they use it for sleep promotion, as well as just to calm themselves, usually in the evenings. 

Trina Wilcox: The bigger topic in all of this, the medical cannabis, a lot of people call it medical marijuana. And I'm not sure, and maybe you can correct me on this, there just hasn't been a ton of research in the United States. How does that compare to other countries? 

Dr. Mary Ann Fitzcharles: We are really all in the same boat. Because even if a product is acceptable recreationally, to actually study a product in a patient, we've got to obtain good manufacturing practices. 

The product has got to be really regulated and perfectly certified. And this has been extremely difficult to obtain really worldwide. There are a few companies that have GMP, so good manufacturing practices; and we are able to access some of those products. And this has been done quite nicely in Europe. 

In Canada, we are just about to initiate a really nice study looking at CBD and THC in patients with osteoarthritis. But it's taken almost three years to get the regulatory authority to give us that GMP certificate. So, you can see that it's, you know, we're there. The researchers are there, the patients are there, we're ready to go, but we really have been roadblocked by regulatory systems. 

Trina Wilcox: Can you tell me a little more about some of the research, especially what you've been involved with? 

Dr. Mary Ann Fitzcharles: There is research looking at products that are pharmaceutical products. There is the product Nabilone, which is a manufactured THC product. There is also Sativex, which is a product that is a pharmaceutical product that is a combination of THC and CBD, and it's an agent that is used as a spray. Nabilone, which is pure THC, is… we just don't see such a very good effect. 

And also there's been one single study in rheumatoid arthritis using Sativex. It was done quite a long time ago. It was done in the United Kingdom, and it had some promise, but unfortunately it's not accessible to our patients. It's not FDA approved for the treatment of pain. It is used in the treatment of multiple sclerosis and particularly patients with spasticity. There've been two randomized control trials that have come out of Europe, one from Vienna and one from Denmark, looking at CBD in osteoarthritis. The study from Denmark was osteoarthritis and psoriatic arthritis. They used different doses of CBD. So, this was CBD alone, not CBD plus THC. And unfortunately, both of those studies… They really were no different from placebo, which was a little disappointing. 

However, we have to listen to what patients tell us. And patients very often say it's a tiny bit of THC that is added to the CBD that seems to make a difference. And this has got to be tested. 

You might have heard about this entourage effect. And an entourage effect is a proposal that it's a mixture of molecules that seem to have a good effect. So again, when we listen to what patients are telling us, patients will say, "I get this particular product, product ABC, and then when I went to get my ABC product, they didn't have the ABC, they had ABD. And ABD was not as good as ABC." So, it brings to our awareness that the complexity of the product of this plan, maybe it's the complexity, and it's the mixture of molecules that's important. 

Trina Wilcox: There's a lot of trial and error left up to the patient at this point. 

Dr. Mary Ann Fitzcharles: You're right. But the patient should not be on their own. And I emphasize repeatedly: Involve your health care provider. Speak to your health care provider. Don't listen to the 22-year-old chap in the dispensary who is selling the product. He is not your health care provider. He is there to sell. Physicians are becoming much more educated and aware about cannabinoids. And I cannot emphasize enough: Speak to your doctor. 

Trina Wilcox: We kind of covered the effectiveness. It kind of depends. And it depends on what mixture is going to work best for the patient. But what about overall safety? 

Dr. Mary Ann Fitzcharles: Right. So generally, we believe that CBD, cannabidiol, is safe if it is taken orally. And we very, very strongly recommend that the agent should not be taken by inhalation. 

Trina Wilcox: Ah. 

Dr. Mary Ann Fitzcharles: So, no smoking, no vaping. Although, when we look at cohort studies, many patients say that they do like to vape a little bit at night. Because what happens with vaping is you have… The blood level of the product is elevated very quickly. So, it's in the system quickly. OK? So, safety: The first thing as a rheumatologist, I will always recommend against inhalation. Number two, we really don't know, we do not have the evidence for, long-term effects in our patients. We have a lot of evidence for long-term effects of recreational cannabis, but this does not necessarily apply to our patients. Long-term effects, so there's a big question.

Number three, we really strongly recommend that young people do not use cannabinoids whilst the brain is developing. Our brain develops throughout pregnancy and childhood until about mid-20s, about 24 or 25 years of age. So, whilst this brain is developing, we have concerns that if you're using an agent such as cannabis, it actually impacts the way in which the neurons connect to each other. We have concerns about young people. 

We also have concerns about people using higher THC levels. In the olden days, which was probably in the 1970s when the hippies were smoking cannabis, the THC content was relatively low. THC content was 3 to 8%. Today, if you go and buy cannabis, even from a regulated supplier in Canada, recreational cannabis, you can get a THC content of up to 30%, which is very, very high. And we know that that type of amount is addictive. 

Trina Wilcox: So, if someone is experiencing arthritis later on in life, and maybe they did use recreationally in their younger years, they should be fully aware that things have changed. 

Dr. Mary Ann Fitzcharles: You are absolutely right. That is really, really important. And this brings us to another point that I think people should be aware of. You should look at cannabis as you would look at any other medication. So, you do not take a few gummies. You do not mix it into brownies or cannabis butter or whatever. If you're using it as a medication, treat it as a medication. Know what quantity you're using, know the milligrams that you're using. And I think this is really important. 

Trina Wilcox: So, when we're talking about dosing and being safe with that, how do you know where to even start? 

Dr. Mary Ann Fitzcharles: Like with many of these medications, start low, go slow. We honestly don't know where to start. And we can look to some of the studies that have been done. And generally, CBD, I would say: Start in the order of about 5 milligrams a day. If you're adding the THC to the CBD, start with a very low dose, something like 2.5 milligrams. 

Trina Wilcox: Does the patient need to be as aware if they're using a topical? 

Dr. Mary Ann Fitzcharles: We don't know. Topicals are really, really interesting. What do we see patients doing? Absolutely using topical, but a topical has got to be able to penetrate into the body. And cannabinoids are an oily substance. And an oily substance cannot penetrate down into the cells. So, it's got to have a vehicle that really allows it to move down. Just buying a topical from a local artisanal product place, we don't know whether it's just going to stay mostly on the top of the skin and how will it get down? 

Trina Wilcox: Excellent. That's real good to know, so we don't spend money on something that might not work. 

Dr. Mary Ann Fitzcharles: Right. 

Trina Wilcox: So, people that may want to try it, what should they know that maybe you haven't covered? What should they look for? What should they avoid? 

Dr. Mary Ann Fitzcharles: I think the first thing is, as we said: Speak to your health care provider. Number two, if you are going to try some medical cannabis, get it from at least a regulated, licensed provider. Don't go to an artisanal provider somewhere on the internet where, in all honesty, you have no idea what is inside the product. Use an oral product that you can know the amount, the exact quantity, that you're trying. 

If you're going to try some cannabis, I would suggest that the first time you use it, you're at home. Everything is quiet, everything is relaxed. And you will try it maybe towards an evening. Not going out, not driving, not doing… Just to assess: How do you feel? And you're looking for positive as well as negative effects. Is it doing anything for your symptoms? Or are you having any side effects? 

And then if you do decide, you think, "Well, maybe this is something that might be helpful to me," give it a proper trial. Six months later, I often speak to patients and say, "Are you still using it?" "Yes." "And what is it doing for you?" "Well, I'm not really sure whether it's helping or not." Be definitive. Give it a defined period of time, and at the end of that time, take a decision. Is it helping, yes or no? And there is no justification to continue any medication unless you are quite sure that you're getting a good effect. 

I think the other thing is: We must still acknowledge that certainly in the United States, it is federally an illegal product. So, patients must adhere to the rules and regulations within the individual state. Because, even if you're using the product medicinally, it will still be considered an illegal product federally if there is more than 0.3% THC. 

Trina Wilcox: All right. Thank you so much. Well, every time we have a podcast coming up, we like to reach out on social media. And so, we asked: "If you have tried medical cannabis for your arthritis, what was the best benefit and biggest drawback?" We had a lot of responses. Dtm.fitness said, "If it weren't for cannabis, I would be in too much pain and anxiety to work out. An edible is the perfect pre-workout for me." 

And then High Enough to Function said, "I use cannabis daily. It's a great alternative to narcotics. The biggest downside is stigma." Can you speak a little on that? I mean, stigma is a big reason a lot of people avoid getting help, even from narcotics. 

Dr. Mary Ann Fitzcharles: Right. So, I think stigma is slowly going to reduce because it is an agent that is now more accepted recreationally. And I think that the public have become really aware that it might be an agent that is of use in people that are suffering. And a very important point is: Could cannabis really be a substitute or help people reduce opioid consumption? And we've talked a lot about the whole issue of the opioid epidemic. 

And there are studies. There's a lovely cohort study from Kevin Boehnke indicating that many patients using cannabis report that they are able to substitute cannabis for some of their symptomatic treatments, including anti-inflammatories, opioids and even benzodiazepines. So, if cannabis could be a substitute for agents that potentially perhaps are more troublesome in the long term, that would be a very good thing. I just want to add one other little caveat of a disadvantage. The big disadvantage is cost. 

Trina Wilcox: Yes. We have a few people that shared that. 

Dr. Mary Ann Fitzcharles: Cannabis is costly, certainly in Canada. If our patients are using it, they're spending about a hundred dollars a month. 

Trina Wilcox: Right. In fact, Butterfly Warrior on Instagram said, "Drawback: price and stigma. It helped me to need less pain meds and last longer before flaring," so that had an advantage for them. And then Quiet One said, "Unfortunately, it made me too anxious to function." And then someone, I am Trina Wilcox, might be my experience: "I had zero benefit, and it was expensive for me to find out that it didn't work." 

I feel like it would be helpful for me to share my story. I have had stomach problems with a lot of NSAIDs. Some of the other pain medications, like anybody that is concerned with their health, you worry that: Is this going to take a toll on me? So, my rheumatologist did say, "You could look into this." He did say he was not educated on it. Like a lot of our medical professionals, they're not trained to know that much about it. 

And before the state that I live in made it legal for recreational use, you had to get the medical card, which costs money, and then you have to go buy it. Like what you said, it is not cheap. The person there tried their best to help me, understanding my situation. I explained I have an autoimmune disease. I want minimal, you know, use that I could get away with. And they still told me to use a little more than I felt like I could handle. 

I started out with half of what they suggested, and in fact, I felt achier than before. I just absolutely did not like the experience. And I think that's important for some people to know, too, that not everybody is going to respond with a wonderful euphoric experience, pain-free and la-di-da. And it does take trial and error in working with your medical professional. 

Dr. Mary Ann Fitzcharles: You've really raised a very, very important point. And the point is that we are all different. Everyone responds to agents differently. There's some people that will take half a glass of wine and say, "I'm going to go to sleep now." And others, very differently. And clearly, some people actually have increased anxiety with cannabinoids. And even a tiny, tiny bit of THC can have psychoactive effects. 

So, we need to be very, very careful in people who are sensitive, such as the older population or people who are on other medications that have some psychoactive effect, such as maybe some of the antidepressants, some of the sleep modulators and alcohol. 

Trina Wilcox: Absolutely. All very important points. Do you have three takeaways from today's episode that you'd like to share with us? 

Dr. Mary Ann Fitzcharles: I think we've really covered most of them. I think my first thing is: Always involve your health care professional. And I really love it when my patients will tell me, "You know, I want to discuss with you the use of some alternative medicine." Or, "I'd like to discuss with you something that I've heard." I think that there should be trust in the patient-doctor relationship, and always discuss with your health care professional. 

Number two: Treat cannabinoids as you would treat any other medicine. So, it's not a brownie that you're going to take a few bites of. It's a medicine. Know the dose, know the effects and know the side effects. And I think the third thing is exactly as you've raised: It's not a magic agent; it's not the panacea for everyone. However, there are quite a number of patients or people that really do do very well. 

Trina Wilcox: Thank you. I think my first takeaway goes right with yours. Talk to your rheumatologist, your medical professional, someone you know that you trust that knows your history with your condition. Number two: Throw stigma out the window. You shouldn't be ashamed of your condition. You shouldn't be ashamed of what works for you. And number three, again, I know people mean well, but please don't listen to someone that treats their recreational habit one way with your medical condition another way. 

I did have someone say to me, "Oh, you shouldn't do that. You should," like you said, "smoke it." I knew that was not for me, and I did not; my little red flag went up. And so, I'm glad to hear you reiterate: That is not a safe way to get proper dosing, you know, so definitely do some research, talk to your doctor, and your friends might mean well, but they're not your doctor. (laughs) 

Dr. Mary Ann Fitzcharles: And can I add just one little point? 

Trina Wilcox: Yes, please. 

Dr. Mary Ann Fitzcharles: Particularly for people being treated with disease-modifying agents for important inflammatory disease, cannabinoids should not replace your standard disease-modifying treatments. It's not a replacement. It would be an agent that could complement perhaps these disease-modifying agents, but it's a symptomatic treatment, not a treatment for the underlying disease process. 

Trina Wilcox: Thank you for joining us. I hope you got some great takeaways. We'll be back next time with another compelling topic. You can get lots more information at arthritis.org. 

Dr. Mary Ann Fitzcharles: Thank you, Trina. And thank you everyone.

PODCAST CLOSING: The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation. Gifts from people like you make our podcast and other life-changing resources possible. You can donate at arthritis.org/donate. This podcast aims to help people living with arthritis and chronic pain live their best life. For a transcript and show notes, go to arthritis.org/podcast. Subscribe, rate and review us wherever you get your podcasts. If you subscribe through Spotify, leave a comment on their platform, letting us know what you think about this episode. And stay in touch!

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