BY JAY SMOKER
In this installment we will examine some of the other medical conditions for which marijuana can be recommended in states other than Colorado.
For example, the medical marijuana laws in Michigan and Maine specifically mention “nail-patella syndrome” as a condition for which medical marijuana may be recommended. So does the Wisconsin medical marijuana bill that failed in the 2010 legislative session. That bill also specifically mentioned another relatively rare medical condition, Ehlers-Danlos syndrome, as well as Post-Traumatic Stress Disorder, or PTSD.
Nail—patella syndrome is a rare genetic disease caused by a mutation in a portion of chromosome No. 9 and occurs in about one in 50,000 individuals. The genetic defect causes abnormalities in connective tissue metabolism and structural defects in collagen, and is inherited as an autosomal dominant trait. This means that it is not associated with the chromosomes that determine gender and is therefore not found more frequently in one or the other gender, and that the disease will be present in at least half of the children as well if the mutation is present in one parent.
Nail-patella syndrome causes fingernail abnormalities, primarily absent or under developed thumbnails, absent or under developed patellae, or knee caps, pelvic abnormalities, and deformation or abnormal development of the radial heads, or bones in the forearms, and in other joints. Nail-patella syndrome is also associated with kidney disease and glaucoma. How the association with glaucoma was discovered is an example of how medical knowledge is sometimes advanced by coincidence and luck,
Dr. Paul Lichter, a physician at the University of Michigan Kellogg Eye Center, noticed that a glaucoma patient he was treating had no thumbnails and abnormal knee caps, and remembered that the patient’s mother, whom he had treated many years before, had the same conditions. Both patients had nail-patella syndrome, as did 24 other members of their extended families, more than 50 percent of who also had glaucoma.
Genetic analysis of these patients showed that the genes associated with their glaucoma are also located on chromosome No. 9, in the same area of the chromosome called 9q34, where the mutation associated with nail-patella syndrome is located. Around 50 percent of all nail-patella syndrome patients also have glaucoma, though it is not known whether the genetic defect that causes nail-patella syndrome also causes the glaucoma. Kidney disease is often part of the syndrome as well, affecting about 40 percent of patients and leading to kidney failure in about 10 percent.
Severe pain due to joint malformations and instability is common in nail-patella syndrome, and treatment is typically to try to reduce the severity of the symptoms, to reduce the pressure within the eye if the patient has glaucoma, and to prevent any kidney problems from progressing to renal failure.
As we’ve seen, marijuana can be used to reduce eye pressure in glaucoma, and is very effective in treating pain. It is important to note that marijuana can be recommended for both of those conditions in Colorado as well, even though nail-patella syndrome is not specifically mentioned in Article 18 of the Constitution of the State of Colorado.
Alan Shackelford, M.D., graduated from the University of Heidelberg School of Medicine and trained at major teaching hospitals of Harvard Medical School in internal medicine, nutritional medicine and hyperalimentation and behavioral medicine. He is principle physician for Intermedical Consulting, LLC and Amarimed of Colorado, LLC and can be contacted at Amarimed.com.