Marijuana Not Helpful For SLE, But Perilous


(ACR2014) Early comparisons of patients with rheumatic disease who use marijuana with those who don't show that the practice is not associated with better pain relief. But it is associated with some "sobering" consequences.

Ste-Marie PA, Shir Y, Rampakakis E, et al. Prevalence of Medicinal Marijuana Use Among 1000 Rheumatology Patients Attending a Community-Based Rheumatology Clinic: A Prospective Cross-Sectional Study. Arthritis & Rheumatism.  ACR 2014, Abstract #265

Jalil B, Sibbitt W, Cabacangun R, et al. Medical Marijuana Related Outcomes in Patients With Systemic Lupus Erythematosus. Arthritis & Rheumatism.  ACR 2014, Abstract #2789

One attendee at the American College of Rheumatology annual meeting in Boston pointed out an irony: It's ever harder for rheumatology patients in the United States to get the opioids that could actually relieve their pain, and ever easier to get marijuana, which doesn't help.

Two presentations at the meeting, perhaps for the first time, document exactly how unhelpful marijuana is for patients with chronic rheumatologic pain.  Peter Ste-Marie and a team at McGill University Health Centre, who have been outspoken about the risks of using pot for this kind of pain, presented results of their prospective study assessing how many of 1,000 patients in a Montreal rheumatologic clinic actually use marijuana for medical or recreational purposes, and what it does for (or to) them, compared to those who don't.

The prevalence is just under 3%, somewhat less than the 4% reported elsewhere. Significantly more marijuana users are unemployed or disabled (46%, as against 8% of non-users), and they are also significantly more likely to report poorer global well-being and pain.

The cause and effect in these associations may be open to question, but the other study is less difficult to misinterpret. Basmah Jalil and her coworkers at the University of New Mexico in Albuquerque undertook a prospective 5-year study of 276 "de-identified" patients with systemic lupus erythematosus (SLE), an ethnically and socioeconomically diverse group, of whom 30% said they used marijuana.

There were no differences between the groups in pain scores, prednisone use, SLEDAI or joint pain and stiffness, but significantly more of the marijuana users also took opiate analgesics (p=0.008).

What stood out were the comorbidities among the marijuana users: a 39% increase in neuropsychiatric SLE and an 85% increase in end-stage renal disease (ESRD) requiring dialysis. Multivariate analysis showed that a staggeringly increased rate of nonadherence to recommended therapy (95%, compared with only 3% among nonusers) completely accounted for the increase in ESRD.

Jalil also reported what she called a "sobering," albeit nonsignificant (p<0.12), increase in mortality of 40% among the pot users.

These results, the team concludes with notable reserve, "are not supportive of a beneficial role for medical cannabis in SLE."

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