Cannabinoids in the rheumatic diseases

Pain is a prevalent symptom for rheumatology patients. Even when inflammatory arthritis is well controlled, remaining pain or comorbid fibromyalgia is a cause of persistent suffering. As current treatments for pain management are suboptimal, patients are increasingly exploring medical cannabis as a treatment option, with interest bolstered by legalization of both medical and recreational cannabis is many jurisdictions. This easier access to cannabis may even prompt some patients to experiment with use and self-medicate. Although the clinical evidence for effect of cannabinoids in rheumatology management is mostly lacking, rheumatologists must be sufficiently knowledgeable to provide patients with evidence-based information about effects and harms. This review will address the pharmacological properties of medical cannabis, products available, and methods of administration and will highlight considerations applicable for use in various rheumatology patient populations. Medical cannabis may provide some symptom relief for some rheumatology patients, but with caution about known short-term risks and largely unknown long-term risks. Medical cannabis may finally emerge as a treatment option for these patients. Even in the present setting of limited evidence, clinicians must understand the popular advocacy for medical cannabis and play an active role to ensure competent and safe patient care. Keywords: Rheumatic pain. Cannabinoids.