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Cannabis and Lupus

Chapter 22 of Treatment of Systemic Lupus Erythematosus describes Systemic Lupus Erythematosus (SLE) as a heterogeneous, multisystem disease that reveals in a unique way per patient, and treatment should be tailored to the type and severity of organ system involvement. As of today, there are still study limitations but there are community standards that help physicians guide treatments and therapies.

Typical symptoms an SLE patient may experience are fatigue, pain, depression, photosensitivity, arthritis, arthralgia, acute pneumonitis, and diffuse alveolar hemorrhage (which is the most uncommon complication).

Current treatments for lupus involve these medications: Glucocorticoids, Hydroxychloroquine, Methotrexate, Azathioprine, Mycophenolate, and Cyclophosphamide. They mostly aid with renal insufficiency and help with major organ functions.

It’s common to have skin issues so skin protection is recommended for photosensitivity, glucocorticoids for lesions, and Hydroxychloroquine for systemic therapy.

Therapeutic Use or the Potential Use of Cannabinoids in this Condition

The article named ‘The Risks and Benefits of Cannabis in the Dermatology Clinic’ mentions preliminary studies show that cannabis can be successful in treating acne, dermatitis, pruritus, wound healing, and skin cancer. Approved medical conditions for cannabis use currently are psoriasis, lupus, nail-patella syndrome, and severe pain.

However, the risks are very concerning and can include oral cancers, oral stomatitis, candidiasis, cannabis arthritis, and angioedema.

Overall, dermatologists need to continue familiarizing themselves with these potential risks as cannabis keeps growing in popularity.

On the other hand, dispensaries have been supportive in providing medical cannabis for dermatologic concerns like treating acne, allergic contact dermatitis, chronic pain, herpes, dermatitis, and lupus.

Research Conducted with Cannabinoids in this Condition

The University of Massachusetts Medical School conducted a study that goes into depth about Ajulemic Acid (AJA). It is an oral, non-psychoactive synthetic cannabinoid-derived drug that binds to the CB2 receptor. It has shown efficacy in inflammation and fibrosis, suppresses tissue scarring, and stimulates endogenous eicosanoids, which also aid in inflammation and fibrosis but without immunosuppression. It is currently developed to be used for Systemic Sclerosis (SSc), Cystic Fibrosis, Dermatomyositis (DM), and Systemic Lupus Erythematosus (SLE).

In clinical trials, AJA has the potential to be a potent inflammation-resolving drug, distinct from NSAIDs, and can aid with various chronic inflammatory diseases. It is also considered disease-modifying, unlike NSAIDs which only relieve symptoms. It also has minimal adverse side effects making it acceptable for chronic administration.

My Thoughts

From the research I've explored in my grad studies, I feel many limitations still don’t allow concrete support. There are several clinical studies out there, but few can validate their statements due to the Schedule 1 status of cannabis.

The existing preliminary research has been very helpful in learning more about cannabis but more controlled trials need to be conducted and evaluated to go into more depth about its safety and effectiveness.

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