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How much cbd oil should i take for arthritis

Does CBD help with arthritis pain?

If you have chronic arthritis pain, you may be wondering about cannabidiol (CBD) as a treatment. CBD, along with delta-9-tetrahydrocannabinol (THC) and other chemicals, is found in marijuana. But unlike THC, CBD is not “psychoactive” — that is, it does not cause the intoxication or high associated with marijuana use.

There’s a good chance you’ve tried it already: according to a Gallup poll in August of 2019, about 14% of Americans report using CBD products, and the number one reason is pain. The Arthritis Foundation conducted its own poll and found that 29% reported current use of CBD (mostly in liquid or topical form), and nearly 80% of respondents were either using it, had used it in the past, or were considering it. Of those using it, most reported improvement in physical function, sleep, and well-being; of note, a minority reported improvement in pain or stiffness.

Perhaps you’ve been tempted to try it. After all, most types of arthritis are not cured by other treatments, and CBD is considered a less addictive option than opiates. Or maybe it’s the marketing that recommends CBD products for everything from arthritis to anxiety to seizures. The ads are pretty hard to miss. (Now here’s a coincidence: as I was writing this, my email preview pane displayed a message that seemed to jump off the screen: CBD Has Helped Millions!! Try It Free Today!)

What’s the evidence it works? And what do experts recommend? Until recently, there’s been little research and even less guidance for people (or their doctors) interested in CBD products that are now increasingly legal and widely promoted.

But now, there is.

A word about arthritis pain

It’s worth emphasizing that there are more than 100 types of arthritis, and while pain is a cardinal feature of all of them, these conditions do not all act alike. And what works for one may not work for another. Treatment is aimed at reducing pain and stiffness and maintaining function for all types of arthritis. But for certain conditions, such as rheumatoid arthritis, conventional prescription medications are highly recommended, because these drugs help prevent permanent joint damage and worsening disability.

In addition, individuals experience pain and respond to treatment in different ways. As a result, it’s highly unlikely that there is a single CBD-containing product that works for all people with all types of arthritis.

What’s the evidence that CBD is effective for chronic arthritis pain?

While there are laboratory studies suggesting CBD might be a promising approach, and animal studies showing anti-inflammatory and pain-relieving effects, well-designed studies demonstrating compelling evidence that CBD is safe and effective for chronic arthritis pain in humans do not exist. A randomized trial of topical CBD for osteoarthritis of the knee has been published, but in abstract form only (meaning it’s a preliminary report that summarizes the trial and has not been thoroughly vetted yet); the trial lasted only 12 weeks, and results were mixed at best. One of the largest reviews examined the health effects of cannabis and CBD, and concluded that there is “substantial evidence that cannabis is an effective treatment for chronic pain in adults.” But there was no specific conclusion regarding CBD, presumably because definitive studies were not available.

Of course, there is anecdotal evidence and testimonials galore, including reports of dramatic improvement by people who tried CBD in its various forms (including capsule, liquid, topical, and spray) for their pain. But we are still waiting for well-designed, scientifically valid, and rigorous clinical trials (such as this one in progress) that are so badly needed to answer the question of just how helpful CBD may be to people with chronic arthritis pain.

Are there downsides to CBD treatment?

As with any treatment, there can be downsides. CBD is generally considered safe; however, it can still cause lightheadedness, sleepiness, dry mouth, and rarely, liver problems. There may be uncertainty about the potency or purity of CBD products (since they are not regulated as prescription medications are), and CBD can interact with other medications. For pregnant women, concern has been raised about a possible link between inhaled cannabis and lower-birthweight babies; it’s not clear if this applies to CBD. Some pain specialists have concerns that CBD may upset the body’s natural system of pain regulation, leading to tolerance (so that higher doses are needed for the same effect), though the potential for addiction is generally considered to be low.

There is one definite downside: cost. Prices range widely but CBD products aren’t inexpensive, and depending on dose, frequency, and formulation, the cost can be considerable — I found one brand that was $120/month, and health insurance does not usually cover it.

Are there guidelines about the use of CBD for chronic arthritis pain?

Until recently, little guidance has been available for people with arthritis pain who were interested in CBD treatment. Depending on availability and interest, patients and their doctors had to decide on their own whether CBD was a reasonable option in each specific case. To a large degree that’s still true, but some guidelines have been published. Here’s one set of guidelines for people pursuing treatment with CBD that I find quite reasonable (based on recommendations from the Arthritis Foundation and a recent commentary published in the medical journal Arthritis Care & Research):

Dos:

  • If considering a CBD product, choose one that has been independently tested for purity, potency, and safety — for example, look for one that has received a “Good Manufacturing Practices” (GMP) certification.
  • CBD should be one part of an overall pain management plan that includes nonmedication options (such as exercise) and psychological support.
  • Choose an oral treatment (rather than inhaled products) and start with a low dose taken in the evening.
  • Establish initial goals of treatment within a realistic period of time — for example, a reduction in knee pain that allows you to walk around the block within two weeks of starting treatment; later, if improved, the goals can be adjusted.
  • Tell your doctor(s) about your planned and current CBD treatment; monitor your pain and adjust medications with your medical providers, rather than with nonmedical practitioners (such as those selling CBD products).

Don’ts:

  • Don’t make CBD your first choice for pain relief; it is more appropriate to consider it if other treatments have not been effective enough.
  • Don’t have nonmedical practitioners (such as those selling CBD products) managing your chronic pain; pain management should be between you and your healthcare team, even if it includes CBD.
  • For people with rheumatoid arthritis or related conditions, do not stop prescribed medications that may be protecting your joints from future damage; discuss any changes to your medication regimen with your doctor.

The bottom line

If you’re interested in CBD treatment for chronic arthritis pain or if you’re already taking it, review the pros, cons, and latest news with your healthcare providers, and together you can decide on a reasonable treatment plan. Depending on the type of arthritis you have, it may be quite important to continue your conventional, prescribed medications even if you pursue additional relief with CBD products.

We may not have all the evidence we’d like, but if CBD can safely improve your symptoms, it may be worth considering.

Follow me on Twitter @RobShmerling

About the Author

Robert H. Shmerling, MD , Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio

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Medical Marijuana: Facts about cannabis, THC, and CBD

Exploring medical cannabis means becoming a highly educated consumer. You need to learn as much as you can from a variety of sources. This guide is intended to help you make a more-informed decision. This guide can’t tell you whether medical cannabis will alleviate your health conditions or symptoms. But it will provide basic information to help you consider whether medical cannabis is right for you, ideally working openly with your physician and other health care providers.

CBD Dosage: How Much Should You Take?

Commissions we earn from partner links on this page do not affect our opinions or evaluations. Our editorial content is based on thorough research and guidance from the Forbes Health Advisory Board.

Table of Contents

  • Determining the Best CBD Dosage for You
  • How to Calculate CBD Dosage
  • How to Take CBD

Cannabidiol (CBD) is growing increasingly popular, thanks to its many purported health benefits and non-intoxicating properties (most CBD products contain less than 0.3% tetrahydrocannabinol, or THC). In fact, 60% of U.S. adults have tried CBD at some point and believe it has medicinal benefits, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll. As research evolves and sheds light on CBD’s efficacy, especially for pain relief, more and more people are adding it to their daily wellness regimens.

Consumers can choose from a variety of CBD products, from oils to gummies to vapes to capsules. But figuring out the safe and effective CBD dose for an individual is a complex decision.

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Here’s how to find the right CBD dosage for you and how to consume it safely.

Determining the Best CBD Dosage for You

With the exception of one CBD product, a prescription drug used to treat seizures associated with particular syndromes, the Food and Drug Administration (FDA) doesn’t regulate the use of CBD. (In fact, it’s illegal to market CBD as a supplement or add it to food.) Therefore, it’s best to consult a doctor with experience in CBD administration to determine your ideal dosage.

Expressed in milligrams (mg), CBD dosage largely depends on the conditions and symptoms you’re trying to treat and your unique endocannabinoid system, which is associated with motor control, behavior, emotions, the nervous system and homeostasis. CBD dosage remains an area of active research—more large, high-quality studies are needed in different populations to determine appropriate dosing, efficacy and safety guidelines.

“It’s best to start small and gradually increase your dose up to a level that gives you the desired effect,” says Cheryl Bugailiskis, M.D., a cannabis specialist at Heally, a telehealth platform for alternative medicine. Your starting point might look like half a CBD gummy or a drop of oil. Ideally, navigate this process under the guidance of a qualified physician.

If you’re still not sure where to start, mydosage.com offers a questionnaire and CBD calculator to help you based on your specific symptoms and usage goals.

How to Calculate CBD Dosage

When you consume CBD gummies, capsules or softgels, dosage is typically expressed per unit. For example, there may be 50 milligrams of CBD in each individual gummy. These products don’t offer much dosage flexibility since you can’t split up capsules easily. For instance, if one softgel capsule didn’t provide your desired result, you would have to take another full capsule, doubling the total dose.

CBD oil, on the other hand, makes it easier, to begin with a small dose. But calculating CBD oil dosage can be less straightforward. Oils and tinctures tend to come in a dropper bottle and, typically, only the total liquid volume and CBD contents are listed on the label. For example, the label might simply state there’s 1,500 milligrams of CBD in the 30-milliliter bottle.

But what does 1 milliliter look like? Due to the current lack of regulation of CBD, this calculation can be tricky. Start by figuring out the volume of a single drop in your dropper, which is usually 0.05 milliliters, according to Dr. Bugailiskis. If you’re unsure, ask the company.

Here’s where math comes in. Let’s continue with the 30-milliliter bottle with 1,500 milligrams of CBD and 0.05 milliliters in a single drop as our example.

1500mg÷30mL = 50 mg/mL

This bottle contains 50 milligrams of CBD per milliliter. Let’s see how many milligrams are in a drop:

50mg/mL ×0.05mL/drop = 2.5mg/drop

Each drop contains 2.5 milligrams of CBD.

Next, you can calculate how many drops you need to reach your goal dosage. Let’s say you want to consume 25 milligrams each day.

25mg÷2.5mg/drop = 10 drops
10 drops ×2.5mg = 0.5mL

With this CBD oil dosage calculator as your guide, you would find that you needed to consume 10 drops, or 0.5 milliliters, to reach 25 milligrams. And if you intend to consume 25 milligrams daily, you can expect this particular bottle to serve as a 60-day supply.

Some CBD products do some of this math for you and illustrate how many milligrams are in a milliliter, some even marking these points on the dropper so you know exactly what you’re taking.

CBD Dosage for Different Ailments

Without FDA approval, there is little guidance in the U.S. on how much CBD a person should consume for various conditions.

In many medical studies on CBD, you see administered doses reach hundreds of milligrams a day, which sounds severe compared to our starting dosage example of 25 milligrams. However, Steven Phan, founder of Come Back Daily, a CBD dispensary in New York, points out that patients in these studies are often dealing with serious flare-ups and pain-inducing conditions compared to everyday dispensary customers.

Below are clinically-studied CBD dosages based on different ailments and conditions. Note: Some of the formulations studied contained THC as well—not all available dosage research sticks strictly to CBD.

Condition Dose* Anxiety 300mg–600 milligrams a day [1] Linares, Ila M. et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test . Brazilian Journal of Psychiatry. 2019;41(1):9-14. [2] Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients . Neuropsychopharmacology. 2011;36(6):1219-1226. Select forms of epilepsy Starting at 2.5 milligrams per kilogram of the person’s body weight twice daily [3] EPIDIOLEX- cannabidiol solution. DailyMed. Accessed 7/4/2021. Central neuropathic and cancer-related pain A maximum of 30 milligrams a day (or 12 sprays) [4] Sativex Oromucosal Spray – Summary of Product Characteristics (SmPC) – (emc). Datapharm. Accessed 7/4/2021. Opioid addiction 400 or 800 milligrams a day [5] Hurd YL, Spriggs S, Alishayev J, et al. Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial. American Journal of Psychiatry. 2019;176(11):911-922. Arthritis A maximum of 30 milligrams a day (or 12 sprays), or 250 milligrams applied topically [4] Sativex Oromucosal Spray – Summary of Product Characteristics (SmPC) – (emc). Datapharm. Accessed 7/4/2021.

*Dosages are based solely on small, short-term clinical study results where CBD proved significantly successful over placebo. Much larger studies are needed to further strengthen the evidence.

FDA-approved Epidiolex administers CBD orally as a liquid to treat seizures associated with Lennox-Gastaut syndrome, Dravet syndrome and tuberous sclerosis complex. The dosage of Epidiolex is determined by taking the patient’s weight in kilograms (kg) into account.

Several countries, including Canada and those in the U.K., have approved the use of Sativex, an oral spray with equal amounts of CBD and THC, to treat pain stemming from multiple sclerosis. Canada has also approved it for treatment of cancer pain.

The medical and research community still has a long way to go before figuring out what dose works best for each condition. At an individual level, consumers can experiment with caution until they find what works best for them.

Partner Offers feature brands who paid Forbes Health to appear at the top of our list. While this may influence where their products or services appear on our site, it in no way affects our ratings, which are based on thorough research, solid methodologies and expert advice. Our partners cannot pay us to guarantee favorable reviews of their products or services

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How to Take CBD

Popular ways to take CBD include:

  • Oils and tinctures (extracts of plant material dissolved in ethanol): A liquid that comes in a bottle with a dropper
  • Gummies: A soft, chewable candy that’s often fruit-flavored
  • Sprays: A liquid that comes in a bottle with a nozzle for spraying into the mouth
  • Capsules: Tablets or softgels that are ingested by mouth
  • Vapes: CBD oil that’s heated without ignition, resulting in an inhalable vapor
  • Flower: Dried hemp plant that’s often ignited and smoked
  • Edibles: Any food that CBD oil has been added to, such as brownies or chips
  • Drinks: Any beverage that’s infused with CBD, often in the form of hemp extract

Your CBD product of choice will largely depend on your personal preferences, as well as your budget since prices vary depending on the potency of ingredients and manufacturing processes. Different mediums also offer varying levels of bioavailability—or how much of what you take is actually absorbed into your bloodstream to have an effect. For example, if you ingest 10 milligrams of CBD via 1 milliliter of liquid, your body might absorb about 60% of it, or about 6 milligrams.

Cannabinoids generally have a low bioavailability compared to other substances, according to Jordan Tishler, M.D., a physician specializing in cannabis treatment in Massachusetts. However, “products that contain emulsifiers like egg yolk (brownies) or lecithin (some gummies) do better,” he says.

With that said, ingesting CBD via gummies or other edibles may take longer to take effect since the CBD has to travel to your digestive system to be broken down and absorbed.

Can You Take Too Much CBD?

Like with any substance, you can take more CBD than your body can handle. Studies show doses up to 1,500 milligrams a day have been well-tolerated, but every person is different [7] Bergamaschi MM, Costa Queiroz RH, Zuardi AW, Crippa JAS. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Current Drug Safety. 2011;6(4):237-49. . Ingesting too much CBD can cause unpleasant side effects, such as dry mouth, nausea, diarrhea, upset stomach, drowsiness, lightheadedness and general disorientation. While rare, liver damage can also occur.

What’s more, CBD can have serious interactions with certain medications. In evaluating available information on five prescription CBD-based medications, researchers found 139 medications could have a potential drug-drug interaction with CBD [8] Kocis PT, Vrana KE. Delta-9-Tetrahydrocannabinol and Cannabidiol Drug-Drug Interactions. Medical Cannabis and Cannabinoids. 2020;3:61–73. . People who take certain blood thinners, heart rhythm medications, thyroid medications and seizure medications need to be particularly careful.

At the end of the day, not all supplements are created equal, which is why it’s important to work alongside a health care provider when adding CBD to your wellness regimen and research reliable brands. And while emerging research and anecdotal evidence is promising, more large, randomized-controlled trials are needed to further understand the benefits of CBD and its dosing.

CBD For Rheumatoid Arthritis

Kimberly is a health and wellness writer with 8 years of experience in healthcare and a special passion for mental health awareness.

Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.

Scott J. Zashin, MD, specializes in the treatment of rheumatologic and musculoskeletal conditions using both traditional and alternative therapies.

As cannabidiol (CBD) has grown in popularity over the years, major organizations like the Arthritis Foundation have released guidelines pertaining to its use in the treatment of rheumatoid arthritis (RA). CBD is a non-psychoactive component of cannabis. The CBD in most products is extracted from hemp, a variety of cannabis that only has traces (up to 0.3%) of THC, the active compound that gets people high. Studies have shown CBD can help reduce chronic pain by impacting endocannabinoid receptor activity, which may also reduce inflammation.

CBD comes in different forms, including oil, vape, edible, and topical. Oils, vapes, and edibles are taken orally, while topical CBD lotions can be applied to the skin. CBD dosage varies depending on the form, the indication, and other treatments being used.

What Is Rheumatoid Arthritis?

RA is an autoimmune inflammatory disease, in which the immune system attacks healthy cells in the body and causes inflammation. RA commonly affects joints in the hands, wrists, and knees, causing the joint lining to become inflamed and damaging the tissue. This causes chronic joint pain and leads to deformity. RA can also affect other tissues throughout the body, such as the lungs, heart, and eyes.

Vera Livchak / Getty Images

Health Benefits of CBD for RA

Animal studies have suggested that CBD has pain-relieving and anti-inflammatory properties, but these effects have not been validated with quality studies in humans. Anecdotally, some people who have tried CBD for treatment of arthritis symptoms report noticeable pain relief, improved sleep improvement, and reduced anxiety.

The trials that have been conducted in humans have not yielded strong evidence for the use of CBD in managing arthritic pain.

  • A randomized trial of topical CBD for treatment of knee osteoarthritis lasted only 12 weeks, and results were mixed.
  • One of the largest reviews examining the health effects of cannabis and CBD concluded that there is substantial evidence that cannabis is an effective treatment for chronic pain in adults. There was, however, no specific conclusion regarding CBD, as definitive studies were not available.
  • More recently, a new study showed that CBD can potentially help alleviate RA pain and inflammation by acting on immune cells that are attacking healthy cells in the body. It’s important to note that this study was also not conducted with human subjects.

Research in this area is ongoing.

If you are interested in trying CBD for RA pain management, be sure to talk to your healthcare provider first before using any CBD products.

Rising Popularity of CBD for RA

Based on a 2019 national survey of 2,600 people conducted by the Arthritis Foundation, 79% of respondents said they were using CBD, have used it in the past, or were considering using it to help with their arthritis pain.

Health Benefits Related to Arthritis

Given the lack of strong scientific evidence supporting the use of CBD, it is not recommended as the first choice for pain relief in RA.

If you have RA, you should not stop taking your prescribed medications that may be protecting your joints from future damage. You should discuss any changes you want to make to your medication regimen with your healthcare provider.

Additional Health Benefits

The strongest scientific evidence for effectiveness of CBD as a medical treatment is for seizure prevention in Dravet syndrome and Lennox-Gastaut syndrome, which are severe childhood epilepsy disorders that typically don’t respond to antiseizure medications. Several years ago, the FDA approved the first cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.

Other potential health benefits of CBD include:

  • Reduce anxiety, insomnia, and depression
  • Relieve cancer or cancer treatment symptoms
  • Clear acne
  • Slow the progress of neurologic disease like Alzheimer’s disease

Possible Side Effects

Treatment with CBD should be started slowly and under the supervision of a healthcare provider, who will oversee its effectiveness and side effects. There have been reports of mild side effects of CBD.

The most common side effects include:

It’s important to note that CBD may interact with other drugs, including some of the medications that are prescribed for the treatment of RA.

Warnings and Interactions

There are some warnings and adverse drug interactions to be aware of before beginning using CBD for management of RA-associated pain.

Warnings

Do not stop taking any other treatments without consulting your healthcare provider. Additionally, CBD shouldn’t be a replacement for other therapies you are using.

Pregnant people and children should consult a healthcare provider before using CBD since there isn’t enough research on the effects of CBD on these populations. There has been concern about a possible link between inhaled cannabis and lower-birthweight babies, but it’s not clear if this applies to CBD.

Currently, the U.S. Food and Drug Administration (FDA) does not regulate the safety and purity of CBD products, so you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. The product may contain other unknown elements. The most effective therapeutic dose of CBD for any particular medical condition has not been established.

Are CBD Products Legal?

CBD products derived from hemp are no longer considered schedule I drugs under the federal Controlled Substances Act, but they still remain in a legal gray zone.   There are changes underway on federal and state levels that will ultimately clarify the laws and regulations related to CBD-based products and sales. Despite that, they’re widely available in nearly every state and online. People who want to use CBD should check their own state laws.

Interactions

Studies have found moderate interactions between CBD and medications commonly prescribed for treating RA.

Interactions can occur with these medications:

CBD can increase your level of coumadin, a blood thinner.

CBD may also raise levels of other medications in your blood by the same mechanism that grapefruit juice does.

Medications that interact with grapefruit juice can potentially interact with CBD, including:

  • Cholesterol medications
  • High blood pressure medications
  • Organ-rejection medications
  • Anti-anxiety medications
  • Corticosteroids
  • Heart medications
  • Some antihistamines

Preparation and Dosage

If you’ve decided to try CBD for treating your RA pain, the next step is figuring out how much to take.

Your dosage depends on a number of factors:

  • Body weight
  • Medical indication
  • The concentration and form of CBD that you’re taking

You will likely need to start with a low dose and find what works for you. Studies have found extreme differences in dosages, with some people using 5 milligrams (mg) and others as much as 600 mg.

Your healthcare provider may direct you to start with 20-40 mg per day and increase slowly each day until you feel the relief you’re looking for.

To ensure that you are using CBD safely and effectively for pain management, you should:

  • Choose an oral treatment (rather than inhaled products) and start with a low dose
  • Establish initial goals of treatment within a realistic period of time. For example, a reduction in knee pain that allows you to walk around the block within two weeks of starting treatment; later, if improved, the goals can be adjusted
  • Tell your healthcare provider(s) about your planned and current CBD treatment; monitor your pain and adjust medications with your medical providers, rather than with non-medical practitioners
  • When preparing to take a liquid form, be aware that the CBD extract is mixed with a carrier oil, so there are two measures to know: the amount of the liquid product to take (the dose) and the amount of CBD in each dose

If CBD alone doesn’t work and you are in a state where medical or recreational marijuana is legal, you could consider talking to your healthcare provider about taking CBD with a very low-dose THC product. Be aware that even at low levels, THC may make you feel high, resulting in cognitive, motor, and balance impairment.

If you experience any unwanted side effects when using a CBD product, immediately discontinue use and inform your healthcare provider.

What To Look For

Look for the following when choosing a CBD product:

  • Look for products manufactured in the United States with ingredients grown domestically
  • Choose products made by companies that follow good manufacturing practices established by the FDA for pharmaceuticals or dietary supplements or required by the state where they are manufactured
  • Buy from companies that test each batch and provide a certificate of analysis from an independent lab that uses validated standardized testing methods approved by the American Herbal Pharmacopoeia (AHP), the U.S. Pharmacopeia (USP), or the Association of Official Agricultural Chemists (AOAC)
  • Avoid companies that claim their products have disease benefits
  • Be aware that marketers and people behind retail counters are not health professionals. Your healthcare provider is your best source for guidance and monitoring when using an unregulated product

A Word From Verywell

CBD may sound like an appealing option for pain relief, but do your due diligence before jumping on the bandwagon. A lot of people say CBD can help reduce pain and inflammation for those with RA, but not a lot of strong scientific data have substantiated that claim. That said, serious effects are not commonly associated with CBD use.

If this is something you are interested in, you can work with your healthcare provider to figure out whether CBD is something you can try safely. Remember that CBD should not be used as a first-line treatment for RA pain and that it’s not advisable to stop taking disease-modifying treatments for RA.