Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, University Hospital Duesseldorf, Duesseldorf, Germany.
Curr Opin Rheumatol. 2019 May;31(3):271-278. doi: 10.1097/BOR.0000000000000590.
An increasing number of patients with rheumatoid arthritis (RA) are using cannabis to treat their symptoms, although systematic studies regarding efficacy in RA are lacking. Within this review we will give an overview on the overall effects of cannabinoids in inflammation and why they might be useful in the treatment of RA.
Peripherally, cannabinoids show anti-inflammatory effects by activating cannabinoid type 2 receptors (CB2) which decrease cytokine production and immune cell mobilization. In contrast, cannabinoid type 1 receptor (CB1) activation on immune cells is proinflammatory while CB1 antagonism provides anti-inflammatory effects by increasing β2-adrenergic signaling in the joint and secondary lymphoid organs. In addition, the nonpsychotropic cannabinoid, cannabidiol (CBD) demonstrated antiarthritic effects independent of cannabinoid receptors. In addition to controlling inflammation, cannabinoids reduce pain by activating central and peripheral CB1, peripheral CB2 receptors and CBD-sensitive noncannabinoid receptor targets.
Cannabinoids might be a suitable treatment for RA, but it is important to target the right receptors in the right place. For clinical studies, we propose a combination of a CB2 agonist to decrease cytokine production, a peripheral CB1 antagonist to prevent detrimental CB1 signaling and to support anti-inflammatory effects of CB2 via activation of β2-adrenergic receptors and CBD to induce cannabinoid-receptor-independent anti-inflammatory effects.
越来越多的类风湿关节炎（RA）患者使用大麻来治疗其症状，尽管缺乏关于 RA 疗效的系统研究。在本综述中，我们将概述大麻素在炎症中的总体作用，以及为什么它们可能对 RA 的治疗有用。
在外周，大麻素通过激活大麻素受体 2（CB2）发挥抗炎作用，从而减少细胞因子的产生和免疫细胞的动员。相比之下，免疫细胞上的大麻素受体 1（CB1）激活具有促炎作用，而 CB1 拮抗剂通过增加关节和次级淋巴器官中的β2-肾上腺素能信号传递提供抗炎作用。此外，非精神活性大麻素大麻二酚（CBD）表现出独立于大麻素受体的抗关节炎作用。大麻素除了控制炎症外，还通过激活中枢和外周 CB1、外周 CB2 受体和 CBD 敏感的非大麻素受体靶点来减轻疼痛。
大麻素可能是治疗 RA 的一种合适方法，但在正确的部位靶向正确的受体非常重要。对于临床研究，我们建议使用 CB2 激动剂来减少细胞因子的产生，使用外周 CB1 拮抗剂来防止有害的 CB1 信号传递，并通过激活β2-肾上腺素能受体来支持 CB2 的抗炎作用，以及使用 CBD 来诱导非大麻素受体依赖性抗炎作用。
