title: Efficacy, Tolerability, and Safety of Cannabinoid Treatments in the Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials.
abstract: To assess the efficacy, tolerability, and safety of cannabinoids (phyto- and syntheto-) in the management of rheumatic diseases.
  
  
  
  Multiple databases, including Medline, Embase, and CENTRAL, were searched. Randomized controlled trials with outcomes of pain, sleep, quality of life, tolerability (dropouts due to adverse events), and safety (serious adverse events), with comparison of cannabinoids with any type of control, were included. Study methodology quality was evaluated with the Cochrane risk of bias tool.
  
  
  
  In 4 short-term studies comprising 203 patients (58 with rheumatoid arthritis, 71 with fibromyalgia, and 74 with osteoarthritis [OA]), cannabinoids had a statistically significant effect on pain in 2, sleep in 2, and improved quality of life in 1, with the OA study prematurely terminated due to futility. The risk of bias was high for all 3 completed studies. Dizziness, cognitive problems, and drowsiness, as well as nausea, were reported for almost half of the patients. No serious adverse events were reported for cannabinoids during the study duration. No studies of herbal cannabis were identified.
  
  
  
  Extremely small sample sizes, short study duration, heterogeneity of rheumatic conditions and products, and absence of studies of herbal cannabis allow for only limited conclusions for the effects of cannabinoids in rheumatic conditions. Pain relief and effect on sleep may have some potential therapeutic benefit, but with considerable mild to moderate adverse events. There is currently insufficient evidence to recommend cannabinoid treatments for management of rheumatic diseases pending further study.
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Fitzcharles
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ste-Marie
authors.affiliation: Klinikum Saarbrücken, Saarbrücken, and Technische Universität München, München, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Häuser
authors.affiliation: University of Michigan Medical Center, Ann Arbor.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Shahin
authors.initials: S
authors.lastname: Jamal
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Jacob
authors.initials: J
authors.lastname: Karsh
authors.affiliation: McGill University Health Centre and Montreal General Hospital Medical Library, Montreal, Quebec, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Landry
authors.affiliation: University of Calgary, Calgary, Alberta, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Leclercq
authors.affiliation: Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Mcdougall
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Shir
authors.affiliation: University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond, British Columbia, Canada.
authors.forename: Kam
authors.initials: K
authors.lastname: Shojania
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Zach
authors.initials: Z
authors.lastname: Walsh
mesh_terms: D002186:Cannabinoids / Q000627:therapeutic use*; D006801:Humans; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy*; D012890:Sleep / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D002186:Cannabinoids