Lupus: Can Cannabis Help?
By Stacey Marie Kerr MD, Hawaiian Ethos Medical Director
What is Lupus?
Lupus Erythematosus (SLE) is an auto-immune, inflammatory, and chronic disease that has been a serious health problem since ancient times. It has variations that affect patients differently, with symptoms that range from mild to quite serious.
One of the most common symptoms of lupus is a rash on the face shaped like a butterfly, and it is this rash that gave lupus its name. A physician in the 13th century thought that the facial rash of these patients looked like the bite of a wolf, so he named the disease lupus, which means wolf in Latin.
A Mysterious Disease
We do not know the cause of lupus, but there is most likely a genetic component that is triggered by environmental factors.  Lupus most commonly starts in women of childbearing age, is more common among Asians and Blacks, and tends to be more severe in those ethnic groups. 
No two cases of lupus are exactly alike. As in other auto-immune diseases, the immune system goes awry and attacks healthy cells. The inflammation and destruction caused by this process spreads throughout the body, and can cause damage to many vital organs including the skin, joints, kidneys, heart, lungs, and brain.  Most patients have mild cases, but the severity of symptoms and the body systems affected are unique to each individual. 
Common Symptoms of Lupus – Depending on which body system is affected by the disease
- Joint pain, stiffness and swelling
- Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body
- Skin lesions that appear or worsen with sun exposure (photosensitivity)
- Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)
- Shortness of breath
- Chest pain
- Dry eyes
- Headaches, confusion and memory loss
There is no known cure for lupus, but there are medications to help manage the symptoms and the progression of the disease. These include:
- NSAIDS (e.g. ibuprofen)
- Anti-malarial drugs (e.g. Plaquenil)
- High-dose steroids that suppress the immune system (e.g. prednisone)
- Other various immune system suppressants (e.g. Imuran, Cytoxan). 
Progress developing new medications for lupus has been slow. In 2011, a new medication specifically for lupus was approved by the FDA – the first one since 1955. However, Benlysta is only helpful for those with mild forms of lupus. 
Most of the medications have side effects that can require monitoring by a physician, so anyone with lupus should work closely with a rheumatologist for their own best care and safety. 
The Immune System and IL-6
The immune system has many chemical messengers that are secreted by cells to affect other cells. These messengers are called cytokines. One type of cytokine is named Interleukin-6 (IL-6). IL-6 sends signals to cells that turn them into inflammatory cells, thus triggering inflammatory reactions. 
Patients with lupus have abnormally large and active amounts of IL-6 both in skin lesions and in their blood.  So what if it is possible to block IL-6 somehow, and stop the overactive inflammation in lupus?
Cautious Optimism for Cannabinoids
Research on this is still in pre-clinical stages, and nothing has been reported on human trials. However, using a powerful THC metabolite as the active cannabinoid, scientists have been able to effectively block IL-6 in lab animals. The symptoms and destructive inflammation of lupus were both improved, giving promise to therapies in the future using cannabinoids to treat humans. 
It is interesting that the THC metabolite used, Ajulemic acid (AJA), was an oral medication that appears to be 50-100 times more potent than THC for pain. It also binds preferentially to the CB2 receptors making it more tolerable and less intoxicating that oral THC. 
So, Can Cannabis Help?
The endocannabinoid system (ECS) works towards homeostasis (balance) in the body. When the immune system is overactive, the ECS works to calm it down. Supplementing the body’s own endocannabinoids with phytocannabinoids from the cannabis plant can increase the effectiveness of the ECS in its efforts to restore balance.
Cannabis does have effects on the immune system, and some promising research has raised hope for the use of cannabinoids to decrease auto-immune damage. But until more work is done on cannabinoids to control disease in human patients with lupus, use of cannabis for painful symptoms and for support of the ECS may be helpful.
The bottom line is that cannabis is a known anti-inflammatory.  Cannabis has also been shown to relieve pain.  Both of these qualities may be helpful for those suffering with lupus. Working with a rheumatology specialist, using the available prescription medications to preserve vital organs while using cannabis for pain and inflammation may provide the best available care.
3. Zhang JM and An J. Cytokines, Inflammation and Pain, Int Anesthesiol Clin. 2007; 45(2): 27–37. doi:10.1097/AIA.0b013e318034194e
4. Zurier, et al. Cannabinoids, inflammation, and fibrosis, FASEB J. 30, 3682–3689 (2016). doi: 10.1096/fj.201600646R>
5. Tackey et al. Rationale for interleukin-6 blockade in systemic lupus erythematosus. Lupus. 2004 ; 13(5): 339–343.
6. Nagarkatti P et al. Cannabinoids as novel anti-inflammatory drugs. Future Med Chem. 2009 October; 1(7): 1333–1349. doi:10.4155/fmc.09.93.
7. Elikottil J, Gupta P, Gupta K. The Analgesic Potential of Cannabinoids. Journal of Opioid Management. 5(6) : 341-357 (July 2013)