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Expert Rev Clin Immunol. 2019 Sep 12. doi: 10.1080/1744666X.2019.1665997. [Epub ahead of print]

Medical cannabis and cannabinoids in rheumatology: where are we now?

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Rheumatology Unit, ASST Fatebenefratelli-Sacco, University of Milan , Italy .
Rheumatology Unit, Internal Medicine Department, ASST Settelaghi, Ospedale Di Circolo - Fondazione Macchi , Varese , Italy .
Rheumatology Unit, University of Messina , Messina , Italy .
Rheumatology Unit, AOU Pisana , Pisa , Italy .
Department of Internal Medicine and Medical Specialities, Rheumatology Unit, Sapienza University of Rome ,
Rheumatological Clinic, Università Politecnica delle Marche , Jesi (Ancona) , Italy .
Rheumatology Unit, P-Dettori Hospital Tempio Pausania , Italy ,
Internal Medicine H, Tel Aviv Sourasky Medical Center , Israel .
Department of Internal Medicine 1, Klinikum Saarbrücken , Winterberg 1, D-66119 Saarbrücken , Germany .


Introduction: Clinicians involved in pain management can finally include cannabis or cannabis-related products in their therapeutic armamentarium as a growing number of countries have approved them for pain relief. Despite the several benefits attributed to analgesic, anti-inflammatory and immunomodulatory properties of cannabinoids, there are still significant areas of uncertainty concerning their use in many fields of medicine. The biosynthesis and inactivation of cannabinoids are regulated by a complex signaling system of cannabinoid receptors, endocannabinoids (the endogenous ligands of cannabinoid receptors) and enzymes, with a variety of interactions with neuroendocrinological and immunological systems. Areas covered: A review of studies carried out during clinical development of cannabis and cannabis medical products in systemic rheumatic diseases was performed, highlighting the aspects that we believe to be relevant to clinical practice. Expert opinion: The growing public opinion, pushing towards the legalization of the use of cannabis in chronic pain and various rheumatological conditions, makes it necessary to have educational programs that modify the concerns and widespread preconceptions related to this topic in the medical community by increasing confidence. More extensive basic and clinical research on the mechanisms and clinical utility of cannabis and derivatives in various diseases and their long-term side effects is necessary.


Cannabis; SLE; cannabidiol; endocannabinoid system; fibromyalgia; rheumatoid arthritis; tetrahydrocannabinol (THC)

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