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Cardiopulmonary disease can affect patients in several ways, with pericarditis the most common and including pleurisy with or without effusion, intrapulmonary nodules, and diffuse interstitial fibrosis. These conditions will result in reduced lung function, having a huge impact on the patient’s quality of life and mobility.
Atherosclerosis is the most common cardiovascular manifestation in RA. It is also the leading cause of death in the RA patient. Because chronic inflammation may be the cause of atherosclerosis, it is possible that early aggressive treatment of RA may reduce the incidence or severity of heart disease .
Neurologic disease is also a complication of RA its most common manifestation is as carpal tunnel syndrome and tarsal tunnel syndrome, these are conditions that involvement entrapments of nerves and produce symptoms along the path of the nerves involved. Atlantoaxial-subluxation is caused when the 1st and 2nd vertebrae become misaligned as a result of RA complications that can lead to fatality in rare cases. .
RA & Quality of Life
An agonist is a chemical that binds to the surface of a receptor and activates it to produce a response. An antagonist binds to a receptor and blocks an agonist by sharing a commonality with the natural ligand .
CBD and THC are cannabinoids that act as both antagonist and agonist for CB1 and CB2 receptors.
In a recent paper, Torsten Lowin, PhD, of the Department of Rheumatology & Hiller Research Center for Rheumatology, University Hospital Düsseldorf, Germany, proposed that a CB1 receptor antagonist combined with CBD and a fatty acid amide hydrolase (FAAH) inhibitor to inhibit the degradation of endocannabinoids could be beneficial in the treatment of RA.
Dr Lowin suggested that patients with RA wishing to try herbal cannabis to address their symptoms should start out with a low THC/high CBD variety and then titrate THC. “High THC might not be favourable because it does increase heart rate and patients with rheumatoid arthritis often develop atherosclerosis .
“Therefore, reduction of proinflammatory cytokine production and signalling without an overt risk of infection would be a preferable treatment of RA,” .
 Osteoarthritis: A Serious Disease, Submitted to the U.S. Food and Drug Administration December 1, 2016, https://www.oarsi.org/sites/default/files/docs/2016/oarsi_white_paper_oa_serious_disease_121416_1.pdf
. Johns Hopkins Arthritis Center by Victoria Ruffing, R.N., C.C.R.P. and Clifton O. Bingham III, M.D: https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-symptoms/
 How is lifespan affected by RA? National Rheumatoid Arthritis Association 02/01/2020:
. Joints for joints: cannabinoids in the treatment of rheumatoid arthritis
Lowin, Torsten; Schneider, Matthias; Pongratz, Georg May 2019: https://journals.lww.com/co-rheumatology/Abstract/2019/05000/Joints_for_joints__cannabinoids_in_the_treatment.9.aspx
 Barrie N, Manolios N. The endocannabinoid system in pain and inflammation: Its relevance to rheumatic disease. Eur J Rheumatol. 2017;4(3):210-218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685274/
 Cannabinoids in the Treatment of RA: Current Status and Future Prospects
Cindy Lampner, MSLIS- May 20, 2019 https://www.rheumatologyadvisor.com/home/rheumatoid-arthritis-advisor/cannabinoids-in-the-treatment-of-ra-current-status-and-future-prospects/