There is a discernible trend among parents and caregivers of children with idiopathic arthritis to consider cannabidiol (CBD) as concomitant or alternative therapy to prescribed pharmaceutical intervention, particularly if the disease is very active or long-running. A recent review article(Pediatr Rheumatol Online J. 2021 Dec 13;19(1):171. doi: 10.1186/s12969-021-00656-5) has evaluated this, and the reasons for it, noting that systematic trials of CBD in arthritis and most other conditions in children have not yet been conducted. The standard treatments in rheumatoid arthritis are non-steroidal anti-inflammatory drugs, corticosteroids, disease modifying anti-rheumatic drugs, and biologic agents. Each carries potential adverse effects, and it appears to be for this reason that CBD, and other forms of complementary and integrative medicine, are administered.
That CBD could seem promising in arthritis is not nonsensical. In animal studies it reduces arthritic pain and inflammation. In human studies this has not been validated, however. And, with the exception of a pair of seizure disorders, evidence for its therapeutic benefit is widely lacking in any pediatric condition. CBD’s safety profile for children has only been characterized among individuals with Dravet and Lennox Gastaut syndrome, moreover. The molecule’s action is complex, widely involving serotonergic 5HT1A receptors through the endocannabinoid system. Because it may interact with the liver enzyme cytochrome P450, there is concern about its possible interference with the metabolism of drugs commonly taken by children with arthritis, notably prednisone, naproxen, and tofacitinib. Over-the-counter CBD product labels, moreover, being frequently inaccurate, dosing issues raise safety concerns among pediatricians.
Survey data show that most of the information about CBD comes to caregivers through television and the internet, not directly from healthcare professionals. Discussions tend not to happen with the patients’ rheumatologists at all. Parents’ expressed reservations are that their children’s doctors would negatively judge them or simply dismiss their interest in CBD. Studies have shown this to be the case involving other conditions as well.
Web search terms like “CBD for children” and “CBD for kids” have certainly increased in the last several years. And blog posts and media forums are growing positive about giving CBD to children. These forms of media frequently refer to preclinical CBD research in animals, and clinical trials in humans showing apparent analgesic activity in some neuropathic disorders, and also its general anxiolytic effects. They note as well that there are indeed trials of CBD in arthritis now underway. (We have written about these in other blog posts.) But as a rule, they do not note that safety and efficacy trials in children with pain or inflammation have not yet been conducted.
As has been shown among adults, children with joint pain or stiffness are being given CBD on a self-perceived as-needed basis, as often as several times per day. The large majority of survey respondents believe that CBD is generally safe because it is a ‘natural’ product. Only 1 in 10 participants in this survey knew what dose they were administering.
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The foregoing is a report on trends and developments in the cannabinoid industry. No product described herein is intended to diagnose, treat, cure or prevent any disease or syndrome.
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