Cannabis has been used to relieve inflammation and autoimmune disorders throughout history. What’s more, research shows that the body’s endocannabinoid system regulates immune function and may play a role in the rise and suppression of autoimmune disorders, including lupus.
This interaction provides a plausible explanation for why some lupus sufferers find relief with cannabis. What’s the connection between the endocannabinoid system and lupus? Can cannabis be a natural alternative or supplement to pharmaceutical drugs? Here’s what you need to know.
The Endocannabinoid System
Consisting of endocannabinoids, their receptors, and the enzymes that synthesize and break them down, the endocannabinoid system (ECS) helps our bodies maintain a healthy state of balance called homeostasis. Only discovered in the 1990s, this system plays a major role in human health, regulating immune function, mood, cognition, pain, sleep, metabolism, and other key processes.
The major components of the endocannabinoid system are the endocannabinoids anandamide and 2-AG, which are produced inside the body as needed. These compounds act through two cannabinoid receptors: CB1 and CB2. Whereas CB1 is abundant in the central nervous system, CB2 is chiefly found in immune cells, highlighting its role in regulating immune system function and inflammation.
These receptors also interact with phytocannabinoids (plant-derived cannabinoids) such as CBD and THC, which explains how cannabis can affect processes in the body.
The endocannabinoid system plays a key role in regulating immune function and by extension inflammation.
Most notably, endocannabinoids have been shown to affect the growth and survival of immune cells, the production of proinflammatory cytokines, the activation of immune cells, and the migration of inflammatory cells. Together, these effects are particularly useful for reducing the excessive immune system activation and inflammation that characterizes autoimmune disorders.
Indeed, recent research investigations show that the endocannabinoid system is involved in disorders characterized by autoimmunity and inflammation, such as multiple sclerosis, celiac disease, and rheumatoid arthritis.
For example, one study found that people with multiple sclerosis had higher levels of anandamide in their brains compared to healthy subjects. Similarly, a 2008 study of arthritis patients reported that they had elevated levels of anandamide and 2-AG in the synovial fluid of their joints.
Finally, a 2013 study in people with celiac disease reported that they had higher levels of CB1 and CB2 receptors in parts of the digestive tract affected by the condition and that these levels returned to normal after the disease went into remission.
Research looking specifically at the endocannabinoid system in lupus patients is scarce. This is in good part due to the fact that research in cannabis has been hindered to its legal status around the world.
The only major study in this area compared the levels of endocannabinoids in healthy individuals and those with lupus, highlighting two key findings:
- People with lupus had elevated levels of 2-AG, which is the main endocannabinoid that binds to CB2 receptors
- There was a link between higher 2-AG levels and lower disease activity, suggesting that the endocannabinoid system was effectively suppressing the lupus
The researchers of this study concluded that “our data confirm that the eCB system critically modulates inflammatory responses and auto-immunity and support evidence of cannabis-based medicine as immune-modulating agents.”
Current data indicates that this system plays a major role in controlling inflammation and immunity and that targeting it through cannabis-based drugs is a promising treatment for autoimmune disorders like lupus.
More studies on the involvement of the endocannabinoid system in lupus are needed. Especially since treatment in Lupus has not been very successful until the present time.
Cannabis & Lupus
There is little research looking at the medical use of cannabis in lupus patients. Indeed, there’s currently only one active clinical trial in this area; it looks at the effects of JBT-101 (lenabasum), a synthetic cannabinoid drug, in people with lupus.
This study will attempt to see if this cannabis-based medicine can relieve lupus pain and inflammation by calming the overactive immune responses that cause the disease. JBT-101 has already shown positive results in studies of other inflammatory and immune-related disorders, including cystic fibrosis and systemic sclerosis.
There is much more evidence that cannabis can relieve the key symptoms of lupus, namely inflammation and pain.
The anti-inflammatory benefits of THC, CBD, and other cannabis-based preparations have been demonstrated in animal models and some human studies of those with autoimmune disorders, such as multiple sclerosis, rheumatoid arthritis, colitis, and hepatitis.
For example, a 2006 study found that the cannabis-based drug Sativex reduced pain caused by rheumatoid arthritis (RA). This study is particularly relevant because both lupus and RA are characterized by joint pain and inflammation that’s caused by an overactive immune system.
Similarly, the pain-relieving effects of cannabis have been reported in dozens of human studies. Most notably, a 2015 systematic review of 28 clinical trials of cannabinoid use for chronic pain concluded that “There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain.” This evidence is strong enough that chronic pain is the most common qualifying condition for medical cannabis.
Lastly, there are anecdotal reports of lupus patients who found relief by using cannabis. While these aren’t rigorously conducted clinical trials, it does offer hope to Lupus sufferers who are suffering from disabling pain in their joints and other parts of their body.
To summarize, more studies are needed to investigate whether cannabis can alleviate lupus. However, there’s plenty of evidence that cannabis can relieve pain and inflammation, including cases where the underlying cause is autoimmunity.
The major side effects of cannabis are psychoactive and include memory impairment, anxiety, euphoria, and paranoia.
These side effects are one of the main reasons why many people turn to preparations rich in CBD, the non-psychoactive cannabinoid. While all types of cannabis can cause minor side effects such as sleepiness, tiredness, dry mouth, and changes in appetite, some do more than others. However, cannabis is a generally safe substance that’s been used for thousands of years, and its side effects compare favorably with many pharmaceutical drugs used to treat lupus, such as NSAIDs, corticosteroids, and immunosuppressive medications. And they are certainly a more attractive alternative for chronic pain than widely prescribed opiates which have caused an epidemic in many areas.
Few countries with medical cannabis programs consider lupus a qualifying condition. For example, only four US states currently list lupus as a valid indication for a medical cannabis prescription.
Nonetheless, most countries and states that have medical cannabis programs consider chronic pain and nausea qualifying conditions. In that sense, if a person’s lupus is severe enough to cause these symptoms, it’s possible to get a prescription even if lupus itself is not listed by name.
It’s theoretically possible to gain access to cannabis for treating lupus in Canada, Germany, the Netherlands, and many other countries with medical cannabis programs. However, some programs, such as those in the UK, are more restrictive.
Meanwhile, in the United States, you can use medical cannabis for lupus in three states: Illinois, Hawaii, and New Hampshire.
In addition, you may be able to get a medical cannabis prescription for lupus-related chronic pain or nausea in the District of Columbia and 30 states: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Washington, West Virginia, Utah, and Vermont.
Research looking at the link between lupus and the endocannabinoid system is just beginning, and it’s too early to say anything conclusive.
Nonetheless, we know that the ECS is involved in healthy immune function and that targeting it through cannabis-based preparations can offer relief for the inflammation and pain that characterize lupus.
Additionally, research shows that cannabis can help with other symptoms of lupus as well, such as headaches, seizures, and nausea.
While this evidence by itself isn’t strong enough for clinicians to recommend cannabis for lupus, it does offer patients an alternative form of treatment, especially when standard medications aren’t working or are causing serious side effects.
Lupus is an auto-immune disorder. It occurs when your body’s immune system attacks your own organs and tissues instead of germs, infections, and foreign bodies. Lupus is a systemic disorder, meaning that it can potentially attack almost any part of the body, including the skin, joints, bones, muscles, heart, lungs and brain.
The name lupus comes from the distinctive rash that often accompanies the disorder, because it’s thought to look like a wolf’s mask, and lupus is the Latin word for wolf.
There are a few different types of lupus, but the most common is called systemic lupus erythematosus, or SLE. Roughly 70% of all lupus cases are SLE, which is the most severe form of lupus. Other types of lupus include:
- Cutaneous lupus erythematosus, which affects the skin
- Drug-induced lupus, caused by taking certain medications, which clears up once you stop taking the medicine
- Neonatal lupus, which affects babies of women with lupus and usually goes away after about 6 months
Every case of lupus is different. Some people have ongoing severe symptoms, but most people have mild symptoms with periods of flares, when the symptoms briefly get worse. Your symptoms might come on gradually, or start very suddenly.
The most common symptoms of lupus are:
- A distinctive butterfly-shaped rash across the cheeks and bridge of the nose, and/or a scaly rash on the face, neck, ears, scalp, and/or chest.
- Joint pain (arthralgia) in any joint in your body
- Lasting fatigue that is more than general tiredness, and doesn’t get any better after you rest.
- Photosensitivity (being sensitive to light), which includes sensitivity to sunlight and artificial light, causing headaches, tiredness, and a rash.
- Hair loss
- Dry eyes
- Difficulty breathing, chest pain, shortness of breath, and/or a stabbing pain in the chest when you breathe, laugh, sneeze, or cough—sometimes this chest pain is caused by an inflammation in the lining of the lungs (pleurisy), or around the heart (pericarditis)
People with lupus can also develop kidney problems like nephritis, which is an inflammation of the kidney and causes high blood pressure, blood in the urine, frothy urine, and swollen legs.
Sometimes, lupus can also cause:
- Memory problems and confusion
- Mouth sores that often don’t cause any pain and don’t look like standard mouth ulcers
- Blood disorders like anemia, low platelet count, low white blood cell count, and frequent blood clots
- Reynaud’s disease, which is when your fingers and toes turn red or blue in cold weather
When to see a doctor
If you have an unexplained rash, fever, persistent tiredness, or aching in your limbs that continues for a long time, you should go to your doctor.
Given that lupus can be very mild or alternatively life-threatening and that symptoms can come and go, accurately diagnosing lupus can sometimes be a challenge. Though the butterfly rash is very distinctive, many people with lupus never develop it. The most common symptoms of tiredness and joint pain could be signs of arthritis, chronic fatigue syndrome, or stress, making it hard to identify.
Your doctor will begin with a full medical examination, checking your joints carefully, and asking about all of your symptoms and medical history. If they suspect lupus, they’ll probably refer you to a rheumatologist who has more experience diagnosing these illnesses.
To help diagnose lupus, your doctor will probably order some or all of these tests:
- Blood and urine tests, to check that your kidneys and liver are working properly.
- A complete blood count (CBC) to check your levels of red and white blood cells and platelets.
- A biopsy of a small piece of tissue from the affected area. A sample taken from the kidneys or the rash while the symptoms are active can definitively diagnose lupus.
- Anti-nuclear antibody (ANA) blood test detects groups of autoantibodies that are found in the bloodstream if you have lupus. If the ANA test is positive, you might get tests for specific antibodies like antiphospholipid antibodies, which are common with lupus.
- Complement proteins tests measures the level of complement proteins, since this is often reduced when you have lupus.
- Erythrocyte sedimentation rate (ESR, or “sed rate”) and C-reactive protein (CRP), which are often high in people with lupus.
There’s no single cause of lupus, but it does seem to be caused by a combination of genetic likelihood and hormonal or environmental triggers. Not everyone with a genetic tendency to lupus ends up developing it, and not everyone exposed to the same environmental triggers develops it either.
Here are some of the most common causes and risk factors of lupus:
- Genetics. If you have a close family member with lupus or a similar autoimmune disease, you are more likely to develop it yourself.
- Gender. Far more women than men develop lupus, and most women who get lupus develop it soon after puberty, during childbearing years, and up until menopause. Generally, women are more prone to getting autoimmune diseases, and this is also true for lupus.
- Age. Lupus is most commonly diagnosed between the ages of 15 and 45.
- Race and ethnicity. People who are of Afro-Caribbean heritage are the most likely to get lupus, followed by Asians and Caucasians.
- Sunlight can trigger lupus in people.
- Some infections, like the Epstein-Barr virus, can provoke lupus or cause a relapse.
- Certain medications, like antibiotics, blood pressure medications, and some anti-seizure drugs can cause lupus. Usually the symptoms dissipate once you stop taking these drugs.
- Environmental toxins like silica, heavy metals, solvents, and pesticides may also trigger lupus.
Lupus is most often treated with a combination of medication, diet, and lifestyle choices, so that the patient can continue to live the same busy, productive life as the rest of the population. On occasion, people with lupus may experience a flare-up, but most of the time, people with lupus experience only mild symptoms.
Medication for lupus
- Non-steroidal anti-inflammatories (NSAIDs) are the first option for people with lupus. You can take over-the-counter NSAIDs like ibuprofen or naproxen sodium, or get stronger versions with a prescription. NSAIDs reduce the painful inflammation around your body that’s caused by lupus.
- Corticosteroids include prednisone, prednisolone, and methylprednisolone. They work fast to reduce inflammation drastically, so they’re often used if your lupus is causing serious damage to your brain or kidneys. However, they can have strong side effects, so you can only take them for a short period of time.
- DMARDs, disease-modifying antirheumatic drugs, like methotrexate, hydroxychloroquine, and sulfasalazine. They can prevent lupus from progressing, slow joint damage, and modify the course of the disease.
- Immunosuppressants are chemotherapy drugs that work to slow down your immune system so that it doesn’t cause so much damage to your body. They are used to stop severe organ damage, but they can also make you very vulnerable to other infections, and cause infertility in women.
- Biologic therapies like Benlysta, which was FDA approved for lupus in April 2019, are also being prescribed more.
Lifestyle and diet
It’s important to get exercise when you can, to keep your joints supple and improve muscle strength. But during a flare up, it’s best just to rest to allow your joints to recover.
People with lupus are usually advised to eat a balanced diet of fruits and vegetables, whole grains, and lean protein, avoiding processed foods and foods that are high in fat.
It’s also best to avoid direct sunlight and cover up while in the sun, since light can trigger a flare up, and to quit smoking.
Many people with lupus take nutritional and herbal supplements to help decrease their lupus symptoms and maintain their overall health. Omega-3 fatty acids in fish oil are popular for their anti-inflammatory activity, and so are antioxidants like vitamin A, vitamin C, vitamin E, and beta-carotene.
Calcium supplements are sometimes recommended, along with Dehydroepiandrosterone (DHEA) supplements that can help with tiredness and muscle pain.
If left untreated, and in some rare cases despite treatment, lupus can lead to serious complications and can even be fatal. The complications of lupus generally include:
- A greater risk of developing cancer
- General vulnerability to infectious diseases, both because lupus affects your immune system’s ability to fight off infection, and because treatments can weaken your immune system
- Complications in pregnancy, including a much higher risk of miscarriage, preeclampsia, and pre-term birth
- Bone tissue death (avascular necrosis), when the bone collapses due to low blood supply to the bone