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Ankylosing Spondylitis (AS) – Cannabis Research

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Overview - Ankylosing Spondylitis (AS)

Description of Ankylosing Spondylitis (AS)

Ankylosing Spondylitis (AS) is a chronic inflammatory disease that principally affects the spine and sacroiliac joints, which connect the spine to the pelvis.


AS is classified within the group of conditions known as spondyloarthritis and is characterized by inflammation that may lead to persistent pain, stiffness, and reduced mobility.


Although the spine is most frequently affected, inflammation may also involve peripheral joints, entheses (sites where tendons and ligaments attach to bone), and extra-musculoskeletal organs such as the eyes, skin, and gastrointestinal tract.


Over time, persistent inflammation may result in structural changes in the spine and, in some cases, fusion of vertebrae that restricts flexibility and range of motion.


The progression of the disease changes considerably, with some individuals experiencing mild symptoms and others developing substantial functional impairment.


Although there is currently no cure for ankylosing spondylitis, treatment strategies that reduce inflammation, maintain mobility, and preserve quality of life can substantially improve long-term outcomes.


Hallmark Clinical Feature: One of the most distinguishing features of ankylosing spondylitis is that symptoms generally improve with activity and worsen with prolonged rest, which helps differentiate it from many mechanical causes of back pain.

Disease Classification

Condition: Ankylosing Spondylitis
Disease Family:
Organ System: Skeletal System
ICD-10 Chapter: Dieases of the musculoskeletal system and connective tissue
ICD-10 Code: M45

Ankylosing Spondylitis (AS) Symptoms:

Chronic low back pain, morning stiffness, sacroiliac joint pain, reduced spinal flexibility, reduced range of motion, fatigue, enthesitis (pain and inflammation at tendon and ligament attachment sites), neck pain, hip pain, shoulder pain, knee pain, ankle pain, sleep disturbances, chest wall pain, reduced chest expansion, postural changes, difficulty standing upright, muscle tightness, muscle spasms, uveitis (iritis), eye pain, eye redness, light sensitivity, blurred vision, psoriasis, inflammatory bowel disease (Crohn's disease and ulcerative colitis), anxiety, depression, reduced physical endurance, impaired mobility.

Also known as:

AS, Axial Spondyloarthritis (axSpA), Non-radiographic Axial Spondyloarthritis (nr-axSpA), Spondyloarthritis (SpA), Inflammatory spinal arthritis

Drug Interactions

THC Interaction with Pharmaceutical Drugs

  • Tetrahydrocannabinol (THC) can enhance the effects of drugs that cause sedation and depress the central nervous system, such as benzodiazepines, barbiturates, and alcohol. 
  • THC is metabolized by an inhibitor of several enzymatic liver pathways referred to as cytochrome P450 (aka CYP450). There are more than 50 enzymes belonging to this enzyme family, several of which are responsible for the breakdown of common drugs such as antidepressants (e.g., amitriptyline, doxepin, fluvoxamine), antipsychotics (haloperidol, clozapine, Stelazine), beta-blockers (e.g., propranolol), bronchodilators (e.g., theophylline), or blood thinners (e.g., warfarin). Thus, patients taking these medication classes may find that THC increases the concentration and effects of these drugs and the impact duration.
  • Clinical observation (not yet confirmed by clinical trials) suggests no likely interactions with other pharmaceuticals at a total daily dose of up to 20mg THC.

If you are interested in the interaction potential of specific pharmaceuticals with THC, consider visiting these free drug interaction checkers: Drugs.com or DrugBank Online.

CBD Interaction with Pharmaceutical Drugs

  • Cannabidiol (CBD) may alter the action of metabolic enzymes (specific drug-transport mechanisms) and alter interactions with other drugs, some of which may produce therapeutic or adverse effects. For instance, CBD interacts with the enzyme cytochrome P450 3A4 and cytochrome P450 2C19, increasing the bioavailability of anti-epileptic drugs such as clobazam (a benzodiazepine). This makes it possible to achieve the same results at significantly lower dosages, reducing treatment costs and risks of adverse effects. 
  • Groups of drugs affected include anti-epileptics, psychiatric drugs, and drugs affecting metabolic enzymes.
  • Clinical observations (not yet confirmed by clinical trials) suggest no likely interactions with other pharmaceuticals at a total daily dose of up to 100mg CBD.

If you are interested in the interaction potential of specific pharmaceuticals with CBD, consider visiting these free drug interaction checkers: Drugs.com or DrugBank Online.

THC/CBD Interaction with Pharmaceutical Drugs

In general, when using cannabinoid-based therapeutics that contain both THC and CBD consider the ratio between them and weigh the relevant information displayed in the individual THC and CBD Drug Interaction windows accordingly.

If you are interested in the interaction potential of specific pharmaceuticals with both primary cannabinoids and THC/CBD, consider visiting these free drug interaction checkers: Drugs.com or DrugBank Online.

Concerns about Cannabis and Cancer-related Immunotherapies:
Some recent clinical observational studies have suggested that the co-administration of cannabinoid-based therapeutics and immunotherapy or immune checkpoint inhibitors in the treatment of certain types of cancer has been associated with worse overall survival rates (T. Taha et al., 2019; A. Biedny et al., 2020; G. Bar-Sela et al., 2020).

However, other studies have suggested that the co-commitment use of immune checkpoint inhibitors and cannabis-induced no such deleterious effects. More specifically, one trial was conducted on animals resulting in data suggesting that cannabis did not negatively affect the properties of immune checkpoint inhibitors (B. Waissengrin et al., 2023). The same authors compared the previous study results with findings from a cohort of 201 patients with metastatic non-small cell lung cancer who received treatment with monotherapy pembrolizumab as a first-line treatment and adjunct cannabis to treat mainly pain and loss of appetite. Their time to tumor progression was 6.1 versus 5.6 months, and overall survival differed between 54.9 versus 23.6 months in cannabis-naïve patients and cannabis-using patients, respectively. However, while numerically different, the authors write that these differences were not statistically significant, leading them to suggest that “These data provide reassurance regarding the absence of a deleterious effect of cannabis in this clinical setting.”

Dosing Considerations

THC Dosage Considerations

  • THC micro dose:  0.1 mg to 0.4 mg
  • THC low dose:  0.5 mg to 5 mg
  • THC medium dose:  6 mg to 20 mg
  • THC high dose:  21 mg to 50+ mg

CBD Dosage Considerations

  • CBD low dose:  0.4 mg to 19 mg
  • CBD medium dose: 20 mg to 99 mg
  • CBD high dose:  100 mg to 800+ mg (upper limits tested ~1,500mg)
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Disclaimer
Information on this site is provided for informational purposes only and is not meant to substitute for the advice provided by your own licensed physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease. If using a product, you should read carefully all product packaging. If you have or suspect that you have a medical problem, promptly contact your health care provider.

Information on this site is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your physician, nutritionally oriented health care practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.