Department of Rheumatology, University of Leicester, Leicester, UK.
University Hospitals of Leicester NHS Trust, Leicester, UK.
Musculoskeletal Care. 2022 Jun;20(2):416-428. doi: 10.1002/msc.1636. Epub 2022 Apr 27.
Cannabinoids have gained popularity recently with special emphasis on their use for chronic pain. Although NICE guidelines advise against their usage for management of chronic pain, almost all rheumatologists encounter a few patients in their daily practice who either use them or are curious about them. We reviewed the mechanism of action of cannabinoids, current knowledge about their role in rheumatology and potential drug interactions with common drugs used in Rheumatology. We attempted to answer the question "If cannabinoids are friend, foe or just a mere bystander?"
We adhered to a search strategy for writing narrative reviews as per available guidelines. We searched PubMed with the search terms "Cannabinoids", "Rheumatology" and "Chronic pain" for published articles and retrieved 613 articles. The abstracts and titles of these articles were screened to identify relevant studies focusing on mechanism of actions, adverse effects and drug interactions. We also availed the services of a musculoskeletal librarian.
Despite the NHS guidelines against the usage of cannabinoids and associated significant stigma, cannabinoids are increasingly used for the management of pain in rheumatology without prescription. Cannabinoids act through two major receptors CB1 and CB2, which are important modulators of the stress response with potential analgesic effects. Their role in various rheumatological diseases including Rheumatoid arthritis, Osteoarthritis and Fibromyalgia have been explored with some benefits. However, in addition to the adverse effects, cannabinoids also have some potential interactions with common drugs used in rheumatology, which many users are unaware of.
While the current studies and patient reported outcomes suggest cannabinoids to be a "friend" of rheumatology, their adverse events and drug interactions prove to be a "Foe". We were unable to arrive at a definite answer for our question posed, however on the balance of probabilities we can conclude cannabinoids to be a "foe". Under these circumstances, a disease and drug focussed research is need of the hour to answer the unresolved question.
大麻素最近越来越受欢迎，特别强调其用于治疗慢性疼痛。尽管 NICE 指南建议不要将其用于治疗慢性疼痛，但几乎所有风湿病医生在日常实践中都会遇到少数使用或对其感兴趣的患者。我们回顾了大麻素的作用机制、目前关于其在风湿病学中的作用的知识以及与风湿病学中常用药物的潜在药物相互作用。我们试图回答“如果大麻素是朋友、敌人还是仅仅是旁观者？”
我们按照现有指南的搜索策略来撰写叙述性评论。我们使用“大麻素”、“风湿病学”和“慢性疼痛”这三个搜索词在 PubMed 上进行了搜索，以获取已发表的文章，并检索到 613 篇文章。筛选这些文章的摘要和标题，以确定专注于作用机制、不良反应和药物相互作用的相关研究。我们还利用了一位肌肉骨骼图书馆员的服务。
尽管国民保健制度反对使用大麻素，并存在与之相关的严重耻辱感，但大麻素仍未经处方被越来越多地用于风湿病学的疼痛管理。大麻素通过两个主要受体 CB1 和 CB2 起作用，这两个受体是应激反应的重要调节剂，具有潜在的镇痛作用。它们在包括类风湿关节炎、骨关节炎和纤维肌痛在内的各种风湿病中的作用已经得到了探索，并且有一些益处。然而，除了不良反应之外，大麻素还与风湿病学中常用的一些药物存在一些潜在的相互作用，而许多使用者对此并不知情。
尽管目前的研究和患者报告的结果表明大麻素是风湿病学的“朋友”，但其不良反应和药物相互作用证明其是“敌人”。对于我们提出的问题，我们无法得出明确的答案，但是从概率平衡的角度来看，我们可以得出结论，大麻素是“敌人”。在这种情况下，需要进行以疾病和药物为重点的研究，以回答未解决的问题。
