Growing Interest in Cannabidiol for Juvenile Idiopathic Arthritis

While cannabidiol (CBD) is currently infrequently used for the treatment of juvenile idiopathic arthritis (JIA), there is a large interest in integrating CBD among the caregivers in this patient population, according to a study published in Pediatric Rheumatology.¹ These results indicate a need for future studies and to educate pediatric rheumatologists about the benefits of CBD.

“Effective treatments for JIA include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease modifying anti-rheumatic drugs (DMARDs), and biologic agents, but each carries potential adverse effects. Indeed, parents and children frequently worry about side effects and the long-term safety of medications prescribed for JIA,” investigators explained. “As a result, many parents and children (34-92%) use complementary and integrative medicine (CIM) [such as CBD] separately or in conjunction with standard treatment of JIA.”

Investigators searched the University of Michigan’s database to identify all children ages 0 through 17 with an ICD-10 code for JIA between January 2017 and December 2019. Eligible participants were parents or guardians of patients with clinically diagnosed JIA who were younger than 18 years of age, had at least 1 visit to Pediatric Rheumatology clinic, and had been evaluated by a rheumatologist in the last 18 months. Participants were invited to complete an 83-item online survey between December 2019 and February 2020. Questions included demographics of both the caregiver and patient, such as age, gender, education, household income, and ethnicity, experience with CIM, parental CBD product and cannabis use, and disease characteristics.

Information, such as perceptions of the safety and efficacy of CBD, the sources of their information, and if they had spoken to their child’s rheumatologist about CBD was collected. Those who were currently treating their child’s JIA with CBD were asked about administration, frequency, disease activity, and daily dosage.

Demographics were similar among participants, with the majority reporting having used at least 1 CIM therapy in their lifetime. Most held a bachelor’s degree or higher, had an annual income of more than $50000 per year, and over 95% were White. High disease activity was more prevalent in families who were interested in or currently using CBD products.

A total of 422 patients with JIA met inclusion criteria, of which 236 caregivers agreed to participate and 136 (58%) ultimately completed the survey. Although only 7% (n = 10) of participants had experience in using CBD products to treat JIA, 54% (n = 79) had contemplated using CBD. Forty-seven (34.5%) did not have any interest in CBD.

Most caregivers learned about CBD from TV (66%), online support groups or blogs (35%), or via a friend or relative (34%). Approximately half (52%) of respondents used at least 2 sources when researching CBD, but only 2% learned about CBD through their child’s rheumatologist. Unsurprisingly, 63% (n = 56) of caregivers did not discuss CBD with the rheumatologist. Reasons given included fearing judgement (35%), concerns about not being taken seriously (29%), or not believing the rheumatologist have adequate knowledgeable on the subject (18%). Despite this, 75% of respondents thought CBD would be able to reduce JIA-related joint pain.

Over half of participants trusted the safety of CBD because it is a natural product, with only 15% believing CBD had any side effects. Products of interest included CBD oil balm (30%), oil drops (25%), oil roll on (23%), gummies (15%), or soft gels/capsules (6.5%).

Of the 10 respondents who were currently using CBD products to treat their child’s JIA, 50% administered CBD orally and 50% used it topically. Most (60%) only used CBD on an “as needed” basis to alleviate joint pain, swelling, and stiffness. Wellbeing (calculated on a scale of 0 to 10) prior to CBD was recorded as an average of 3.6 and increased to 5.3 post-administration. However, only half of caregivers reported a noticeable improvement in their child, while 30% noticed no change and 20% saw a decrease in wellbeing. Only 1 parent knew the dose of their child’s CBD.

Over 95% of participants were White, which does not represent the typical JIA patient population and therefore hinders generalizability. As parents chose to participate in the survey, there may be an element of selection bias. Another limitation is that the parents/guardians of patients with JIA were surveyed, as opposed to the patients themselves, so investigators could not determine the individual’s interest in CBD.

“It is important that pediatric rheumatologists and other pediatric providers educate themselves about CBD to increase their comfort in discussing CBD and its potential safety issues with their patients and/or parents,” investigators concluded. “Such efforts should focus on harm-reduction, communicating uncertainty without harming the patient-physician relationship, and guiding interested parties to reliable sources on CBD (eg the Arthritis Foundation) to ensure that they are obtaining information based on scientific evidence. In addition, rigorous clinical studies are warranted to investigate both safety and efficacy of CBD in JIA to bridge the gap in knowledge.”

Reference:

Failing CJ, Boehnke KF, Riebschleger M. Cannabidiol (CBD) Use among children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2021;19(1):171. Published 2021 Dec 13. doi:10.1186/s12969-021-00656-5