Background/Purpose

Medical cannabis is used extensively in the United States, usually in the form of smoked marijuana. There is growing research regarding the immunomodulatory effects of cannabinoids and the cannabinoid receptor system as a possible therapeutic target. Despite the increasing use of medical marijuana, almost all studies report short–term subjective effects of medical cannabis with little to no real outcome data in medical disease and systemic lupus erythematosus (SLE) in particular. Randomized, controlled trials of smoked cannibis are generally considered ethically problematic.  This study determined whether cannabis was associated with important outcomes in SLE, including mortality and morbidity.

Methods

This is an analysis of a prospective de-identified 5 year longitudinal outcome study of a cohort of SLE patients at the University of New Mexico with a sample size of 276 patients with 30.4% using marijuana and 69.5% with no marijuana use.  All patients had signed informed consent, but additional IRB approval was obtained prior to analyzing the de-identified database in relation to cannabis. Inclusion criteria were any patient with SLE, age 18-80. Exclusion criteria were any patient with a diagnosis other than SLE, age < 18 years, age > 80 years. The population sample was diverse and included all social and ethnic backgrounds, with Hispanics and Whites being the dominant participants. This analysis was supported by the University of New Mexico. Outcomes were determined at 5 years after enrollment in the study.

Results

No significant difference was observed in age, gender, SLE disease duration, SLE criteria, ANA titer, dsDNA titer, antiphospholipid Ig G, M, A, RF, anti-ribosomal P, incidence of Sjogren’s syndrome between marijuana and non-marijuana users. Ethnically these groups were also similar.

However marijuana users were more likely to use opiate analgesics (p value 0.008), even though no differences were reported between pain scores, prednisone use, SLEDAI or joint pain/stiffness between the 2 groups. With marijuana use there was a 39% increase in neuropsychiatric SLE (p=0.04), a 85% increase in end-stage renal disease requiring dialysis (p<0.006) and a 40% increase in mortality (p<0.12). With multivariate analysis, the association of marijuana on the increase in ESRD could be explained completely by an increase in non-compliance/nonadherence to recommended therapy (non-marijuana: 3% noncompliance vs. marijuana use: 95% non-compliance, p value < 0.001). 

Conclusion

This 5 year outcome study indicates that marijuana use in SLE is not associated with reduced pain, use of prednisone, narcotic analgesics or SLE disease activity. However, marijuana use in SLE is associated with an increased incidence of neuropsychiatric SLE, death, narcotic use, end stage renal disease, and noncompliance/nonadherence to recommended therapy.  These epidemiologic data are not supportive of a beneficial role for medical cannabis in SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/medical-marijuana-related-outcomes-in-patients-with-systemic-lupus-erythematosis/