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Can Cannabis Help Gout Patients?

by Emily Earlenbaugh, PhD

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Feb 27, 2020

Overview

For thousands of years, cannabis has been recommended as a treatment for gout, and gout patients have anecdotally reported that cannabis can help reduce their swelling and pain. But in modern times no research has been done on whether cannabis can actually help with gout, as reported. 

Still, gout is an arthritic condition, and there is a fair bit of evidence suggesting that cannabis can be a helpful treatment for similar arthritic conditions which cause inflammation of the joints. Scientific studies show that joints, bone, and muscle all contain a working endocannabinoid system, and some types of arthritis lead to changes in that system. In addition, stimulating that system has been shown to help reduce inflammation, protect joints from damage, and reduce pain. So, while more research is needed on gout and cannabis specifically, what we do know suggests that cannabis could be helpful for the condition and its symptoms. 

How Cannabis Works on Gout  

While there is no real research looking at whether cannabis may help with gout, there is a fair bit of evidence suggesting that it can help with other forms of arthritis — such as rheumatoid arthritis. While gout may respond differently than these other inflammatory joint conditions, this body of literature can shed some light on how cannabis is likely to work with gout. 

For one thing, joint inflammation could be connected to an imbalance in the endocannabinoid system (ECS), which exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.

One study found that patients with rheumatoid arthritis actually have a higher level of CB2 receptors in their damaged joints. These receptors are able to activate the endocannabinoid system to produce strong anti-inflammatory effects — without any inebriating or euphoric effects. Thus researchers have suggested further studying whether activating this receptor (potentially with cannabinoids) could relieve the joint inflammation from rheumatoid arthritis. 

Another study on both rheumatoid arthritis and osteoarthritis patients, examined the endocannabinoid activity in the fluid in their joints and found increased endocannabinoids such as anandamide and 2AG. The authors also found that stimulating the endocannabinoid system resulted in chemical changes that could be beneficial for the treatment of these arthritic conditions. 

In addition, stimulating the endocannabinoid system is well known to produce pain relief, which can be a big help for all kinds of chronic pain conditions, and has the potential to aid with the pain from gout. 

Until we have more research on how the ECS impacts gout (and vice versa) we can’t say for sure how cannabis might work to help — but the research we do have suggests that stimulating the endocannabinoid system receptors can help activate our bodies natural ability for pain and inflammation relief. Since these are the main symptoms of gout, we have good reason to think that these are ways cannabis could be helping.

Research on Gout and Cannabis

There is no peer-reviewed research on using cannabis for gout, which is a bit surprising given that treating gout is one of the oldest known uses for cannabis. It has been recommended as a cure for gout in ancient Chinese medicine as far back as 3750 B.C.A., as well as by sources like Pliny the Elder in 77 AD, and in our more recent past was listed as a cure for gout in the 1868 US dispensatory (a book containing descriptions of drugs and their uses). In addition, some gout patients report cannabis helps with the pain and inflammation. 

Despite this, there have been no modern studies on this use for cannabis. Still, research on other inflammatory joint conditions, such as rheumatoid arthritis, can shed light on how cannabis may be able to help. 

For one thing, cannabis’ anti-inflammatory properties are well-established from animal models of rheumatoid arthritis. In experimental models, these effects have been shown to protect the host from the progression of diseases like rheumatoid arthritis and a number of other autoimmune disorders via multiple different anti-inflammatory pathways. 

In addition, there are many patients already using cannabis for arthritis. One Australian study, for example, found that 35% of cannabis users did so for arthritis symptoms. In another study on cannabis use in the UK, researchers found that 21% of cannabis users did so specifically to relieve arthritis symptoms. Of those who used illicit cannabis 46% did so for rheumatoid arthritis. Interestingly, 100% of those using illicit cannabis for their rheumatoid arthritis said that it improved their condition, with 72% reporting that it made their condition much better, and 28% saying it made it a little better (28%). 

Given these anecdotal accounts of cannabis helping with arthritis, researchers have done a few studies on humans to confirm whether cannabis is actually helping. For example, one double blind study looked at cannabis for pain in rheumatoid arthritis patients. The researchers found that Sativex, a cannabis-based medicine, could not only relieve pain for these patients, it could also suppress the activity of the disease

Cannabis may also help by aiding sleep of patients with inflammatory conditions. One study looked at whether Sativex could help with sleep for chronic pain patients with conditions including arthritis. They found that it produced better sleep, and patients continued to see this results in studies up for 4 years after beginning use.  

CBD and Gout 

Like with cannabis in general, we don’t have any studies to draw on that look at CBD, a non-hallucinogenic compound in cannabis, and gout. But we do have research suggesting that CBD could help with other inflammatory conditions that are similar to gout. Animal models of arthritis, for example, show that CBD can actually stop the progression of the disease. CBD can also reduce oxidative stress which can be helpful for arthritis treatment and animal studies show that topical CBD can provide direct reduction in inflammation and pain when applied directly to the swollen area. 

Side Effects

Given the lack of research on cannabis and gout, we don’t have much insight on whether there are particular negative side effects for this using cannabis with this condition. Still, cannabis’ side effects are generally mild and manageable. They can include symptoms like mild difficulties in concentration and memory, impaired coordination, nausea, light-headedness, increased appetite, racing heart, dry mouth and eyes, and fatigue.

In addition, cannabis may slow the metabolism of certain drugs, thus increasing the amount present in the bloodstream. This can cause a negative interaction with some drugs, leading to an overdose of the other medication, so those taking other medications should consult with a doctor before beginning cannabis use. 

Cannabis Side Effects

Disclaimer

The Cannigma content is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with an experienced medical professional with a background in cannabis before beginning treatment.

About Gout

Gout is a type of inflammatory arthritis that can affect anyone. It occurs when levels of uric acid in the body spike suddenly, creating excruciating pain and inflammation in the joints.  

Gout is traditionally connected with eating and drinking too much, especially wine, beer, spirits, and red meat. Since the 1990s, gout has been steadily on the rise in western countries, possibly due to increased obesity rates, as well as the side effects of a type of blood pressure medication. 

Gout affects around 4% of the US adult population and 2.5% of people in the UK, making it a very common pain condition. Men are three times more likely to develop gout than women, until around 60 years of age, at which point both men and women are at equal risk.

The primary symptom of gout is a sudden, severe attack of pain in a joint. The big toe joint is most often affected, although gout can also strike the ankles, knees, elbows, wrists, and fingers. Typically, an attack of gout occurs at night, with severe pain coming on suddenly and lasting for 4-12 hours. 

After the severe pain subsides, lingering discomfort can continue for up to a few weeks. Some people with gout only have one attack, but 60% have another one within a year. 

Gout is divided into four stages:

  • Asymptomatic hyperuricemia. This is the time before your first attack of gout, when you don’t have any symptoms, but your blood uric acid levels are already high. Most people don’t realize they have gout at this stage.
  • Acute gout. This is when you have a gout attack, often after a night of heavy drinking and/or eating raises your uric acid levels. 
  • Interval gout is the time after an attack. During this time you probably won’t feel any symptoms, but gout hasn’t gone away. Low-level inflammation could still be damaging your joint without your knowledge.
  • Chronic gout. This is when your uric acid levels have been high for a long time, attacks come frequently, the pain doesn’t go away as it used to, and joint damage may have occurred, leading to a loss of mobility. 

If you don’t treat gout and make some lifestyle changes, you’re at risk of complications. These include:

  • Joint damage from recurrent gout attacks
  • Kidney stones
  • Urate crystal deposits called tophi that appear as tiny white lumps under your skin and can get swollen and painful during gout attacks

It can be difficult to diagnose gout because the symptoms can be similar to other conditions, like other types of arthritis. You can expect your doctor to examine your joints, and ask you about your diet. Tests used to diagnose gout include:

  • A blood test to measure the level of uric acid in your blood, although some people with high blood uric acid levels don’t have gout, and some people with gout have low levels of uric acid in the blood. 
  • X-ray imaging to rule out other causes of joint inflammation.
  • A joint fluid test that uses a thin needle to take a sample of fluid from the affected joint, and examine it under a microscope for urate crystals.
  • Musculoskeletal ultrasounds to look for urate crystals around the joint, or in tophi.

Gout is caused by high levels of uric acid in the blood, which then build up into needle-like crystals within a joint. Those crystals cause sudden, severe attacks of pain, inflammation, swelling, and heat in the joint. 

Your body produces uric acid naturally when it breaks down the purines in your body and the food you eat. Normally, your kidneys get rid of uric acid through urine, but if your kidneys aren’t working properly, or you eat too much food that’s high in purines, your kidneys might not be able to excrete all the uric acid and it builds up in your bloodstream. 

Foods that are high in purines include red meat, seafood, beer and other alcoholic drinks, and drinks sweetened with fructose. 

Risk factors for gout include:

  • Obesity, which puts a greater strain on your kidneys
  • A diet high in red meat, alcohol, seafood, and other foods that are high in purines
  • Certain medical conditions like diabetes, heart disease, kidney disease, untreated high blood pressure, and metabolic syndrome
  • Taking some medications, like diuretics for high blood pressure, low-dose aspirin, some immunosuppressant drugs prescribed for rheumatoid arthritis and psoriasis
  • A family history of gout

If you already have gout, then stress, illness, and bruising or injuring a joint can bring on an attack. 

Combined with lifestyle changes, the right medication can reduce the pain of gout attacks and prevent them from recurring. 

Medication for gout attacks

  • NSAIDs, like over-the-counter ibuprofen and naproxen sodium, and/or stronger prescription painkillers like indomethacin or celecoxib.
  • Colchicine, which is a pain relief medication for gout pain.
  • Corticosteroids like prednisone could be prescribed as an injection or in pill form. They are usually only prescribed for people who can’t take NSAIDs or colchicine. 

Medication to prevent future attacks

After the pain of an acute attack has died down, your doctor might prescribe a lower daily dose of NSAIDs or colchicine to reduce the risk of future attacks. 

You might also be given uric-acid lowering medication like allopurinol and febuxostat, which are xanthine oxidase inhibitors (XOIs).

Alternatively, your doctor might prescribe medication to improve uric acid removal from your body, called uricosurics. These include probenecid and lesinurad. 

Lifestyle changes to deal with gout

It’s very important to change your diet and lifestyle, even if you’re taking gout medication. Recommendations include:

  • Drinking plenty of fluids to keep yourself hydrated
  • Avoiding too much alcohol and drinks sweetened with high-fructose corn syrup 
  • Losing weight carefully, because drastic weight loss can raise uric acid levels
  • Cutting down on red meat and oily fish, and eat a healthy, balanced diet
  • Stopping smoking
  • Exercising regularly, but without putting too much stress on your joints

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