Ketamine: The “New” Anti-Inflammatory Medicine

Ketamine has proven itself to be an effective medication for procedural sedation. Now we are seeing how ketamine can treat and alleviate mood disorders such as depression, anxiety, and chronic pain disorders.  Experiments are also showing how ketamine can reduce inflammation.

Inflammation is a normal process of the body. It is the body’s immune system at work to prevent infections from viruses, bacteria, and fungi.  The immune system has a miraculous ability to detect and destroy foreign invaders that attempt to establish a foothold in your body. However, there are times when the immune system starts attacking the body it was meant to protect. One example of this is rheumatoid arthritis (RA), which is an autoimmune disease that creates inflammation in the joints.

One of the key components of inflammation is tumor necrosis factor alpha (also known as TNF-α). TNF-α is important in cell signaling for the immune system [1].  Studies show that TNF-α plays a central role in rheumatoid arthritis, Crohn’s disease, and psoriasis.

Flip on the TV, and you’ll probably see a happy looking woman doing yoga or an elderly couple dancing advertising a monoclonal antibody that targets TNF-α such as Remicade (infliximab), Humira (adalimumab), and Cimzia (certolizumab pegol). These treatments lower the available TNF-α in the body which in turns lowers inflammation causing damage to the joints. Reductions in TNF levels improves the signs and symptoms of RA and reduces radiographic progression of the disease [2].

Ketamine is possibly an alternative or adjunct to these drugs. Early experiments show that ketamine demonstrates an anti-inflammatory effect, specifically reducing TNF in humans, horses, and rats. Check out this table below summarizing early experiments [3]:

While there are no large double blind treatment trials regarding ketamine and it's use in treatment for inflammation in humans, there is one case report by Dr. Hanna, a ketamine physician in Clearwater, FL who gave IV ketamine for his patient with rheumatoid arthritis [4].

He reported, “Since I had great success treating severe pain associated with other auto-immune diseases like MS, and Lichen Sclerosis, I thought that I would expand the treatment for Rheumatoid Arthritis and we had a great success with Teresa. “

So is there a role of ketamine for auto-immune diseases?  It’s a little early to say, but there is a strong potential.  Is it possible that depression, anxiety, PTSD, fibromyalgia, chronic pain have some sort of similar auto-immune inflammatory process we are not aware of yet?  Often many people with auto-immune diseases also battle depression and anxiety. So if someone cannot tolerate traditional treatment for rheumatologic diseases and is depressed, ketamine might just be the answer they are looking for. 

References:

  1. Shealy, D. J., and S. Visvanathan. “Anti-TNF Antibodies: Lessons from the Past, Roadmap for the Future.” Therapeutic Antibodies Handbook of Experimental Pharmacology, 2008, pp. 101–129., doi:10.1007/978-3-540-73259-4_5.

  2. Manara M, Sinigaglia L. Bone and TNF in rheumatoid arthritis: clinical implications. RMD Open. 2015;1(Suppl 1):e000065. doi:10.1136/rmdopen-2015-000065.

  3. TABLE 1: Kock, M.D., et al. “Ketamine and Peripheral Inflammation.” CNS Neuroscience & Therapeutics, vol. 19, no. 6, 2013, pp. 403–410., doi:10.1111/cns.12104

  4. “CBS News Features Amazing New Rheumatoid Arthritis Treatment With IV Ketamine By Dr. Ashraf Hanna.” PR Newswire: News Distribution, Targeting and Monitoring, PRNewswire, 17 Jan. 2017, www.prnewswire.com/news-releases/cbs-news-features-amazing-new-rheumatoid-arthritis-treatment-with-iv-ketamine-by-dr-ashraf-hanna-300392076.html.