Can-Art Effect and safety of using Canabis derivatives for the treatment of pain in patients with inflammatory Arthritis, such as reumatoid arthritis and ankylosing spondylitis, the latter being a type of arthritis that causes a long term inflammation of the joints of the spine. A randomized, double blinded, placebo controlled trial, i.e. in this drug trial, a control group is given a placebo while another group is given the Cannabis derivative being studied

INTERVENTION: Product Name: Cannabidiol tablet 10 mg Pharmaceutical Form: Tablet CAS Number: 13956‐29‐1 Other descriptive name: CANNABIDIOL Pharmaceutical form of the placebo: Tablet Route of administration of the placebo: Oral use Product Name: Dronabinol capsule 2.5. mg Pharmaceutical Form: Capsule INN or Proposed INN: DRONABINOL CAS Number: 1972‐08‐3 CONDITION: Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) ; MedDRA version: 20.0 Level: PT Classification code 10039073 Term: Rheumatoid arthritis System Organ Class: 10028395 ‐ Musculoskeletal and connective tissue disorders ; MedDRA version: 20.0 Level: PT Classification code 10002556 Term: Ankylosing spondylitis System Organ Class: 10028395 ‐ Musculoskeletal and connective tissue disorders Therapeutic area: Diseases [C] ‐ Musculoskeletal Diseases [C05] PRIMARY OUTCOME: Main Objective: RA and AS are systemic autoimmune diseases characterized by chronic, systemic inflammatory conditions, primarily of the musculoskeletal system. Pain and fatigue are typical symptoms and their treatment is a clinical challenge. The present study aims to clarify the potential of medical cannabis as a complement to the existing treatment in RA and AS.; ; More precisely, the study aims to clarify in RA and AS patients, whether the “add‐onâ€? treatment with CBD (placebo controlled) or the combination of CBD and THC (open label) results in a significantly improved pain situation as assessed by the number of patients achieving an improvement of pain visual analogue scores (VAS) with a reduction of ? VAS > 20. Primary end point(s): The study investigates the effect of CBD, more specific whether the add‐on treatment with CBD results in a significantly improved pain situation as assessed by the number of patients achieving an improvement of pain‐VAS with a reduction of ? VAS> 20. Assessment takes place after 12 and 24 weeks of active treatment with CBD. ; ; B. If the patient does not experience an acceptable effect of the CBD treatment in the assessment after 12 weeks (as defined by study protocol, i.e. pain VAS reduction > 20), the randomization is terminated and the treatment proceeds by a combination of CBD and THC. ; THC 2.5 mg daily in week 13 and 14, increasing to 5 mg (2.5 mg x 2 daily) in the following two weeks. If no effect has occurred after week 16, the dose increases in the beginning of the 17th week to the maximum of 7.5 mg THC (2.5 mg x 3 daily) in the 3rd week; ; ; 2. Thus, the study investigates the effect of the combination of CBD and THC, more specific whether the add‐on treatment with CBD for 12 weeks followed by the combined treatment of CBD and THC for another 12 weeks results in a significantly improved pain situation as assessed by the number of patients achieving an improvement of pain‐VAS with a reduction of ? VAS> 20. Assessment takes place after 12 and 24 weeks of active treatment with CBD and after 12 weeks of active treatment with CBD followed by another 12 weeks combined treament with CBD and THC. ; Secondary Objective: A significantly improved pain situation as assessed by the number of AS patients that achieve a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) < 40 and / or improvement in BASDAI with ? > 20 after 12 and/ or 24 weeks of treatment with CBD or 12 weeks of treatment with CBD followed 12 weeks of treatment with the combination of CBD and THC in an open follow‐up.; ; A significantly improved life situation as assessed by the number of patients that achieve a Global VAS < 50 and / or an improvement in Global‐VAS with ? VAS> 20 after 12 and/ or 24 weeks of treatment with CBD or 12 weeks of treatment with CBD followed by 12 weeks of treatment with a combination of CBD and THC in an open follow‐up study.; ; The effect of the intervention on the patients attention and concentration is investigated using cognitive tests (Trail Making Test (TMT) and Digit Symbol Substitution Test (DSST)). Additionally, sleep quality is evaluated with the Pitssburgh Sleep Quality Index. Timepoint(s) of evaluation of this end point: During this study period, the participants are invited to four visits at one of the participating centers. At baseline and after 12 and 24 weeks( ± 7 days) respectively, the key data i.e. the pain VAS scores are determined and registered in the Danish nationwide quality registry DANBIO.; ; Briefly the data are obtained at consultation visit 1 (baseline), a consultation visit at week 12 ± 7 days, another consultation visit at week 24 ± 7 days.; Furthermore a follow up consultation visit will take place at week 36 ± 7 days and define this endpoint 12 weeks after the active treatment is terminated.; ; SECONDARY OUTCOME: Secondary end point(s): Secondary outcomes; 1) Outcomes: Clinical measurements, i.e. in RA the Disease Activity Score 28‐joints (DAS28‐CRP), Health Assessment Questionnaire (HAQ) and in the case of AS the Ankylosing spondylitis disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis (BAS)‐scores for disease activity (BASDAI), function (BASFI) and measures (BASMI) are registered . Patient Reported Outcome Measures (PROMs) more specific, visual analogue scales (VAS) for fatigue, patient’s global; the Quality of Life (QoL) ‐ and pain‐ scores SF‐36 and PainDETECT are obtained. ; Furthermore, the effect of intervention on attention and concentration is investigated using the following cognitive test: Trail Making Test (TMT) and Digit Symbol Substitution Test (DSST). Additionally, sleep quality is evaluated with the Pitssburgh Sleep Quality Index and the expected effect for treatment is measured with Credibility/expectancy Questionnare Devilly and semistructured course interviews.; ; Thus, the study investigates the effect of CBD, more specific whether the add‐on treatment with CBD results in a significantly improved fatigue situation and as well more holistic qulaity of life situation as assessed by the number of patients achieving an improvement of fatigue‐VAS with a reduction of ? VAS> 20 and an improvement of global‐VAS with a reduction of ? VAS> 20. ; Assessment takes place after 12 and 24 weeks of active treatment with CBD. ; ; Furthermore, the study investigates the effect of the combination of CBD and THC, more specific whether the add‐on treatment with CBD for 12 weeks followed by the combined treatment of CBD and THC for another 12 weeks results in a significantly improved fatigue situation and as well more holistic qulaity of life situation as assessed by the number of patients achieving an improvement of fatigue‐VAS with a reduction of ? VAS> 20 and an improvement of global‐VAS with a reduction of ? VAS> 20. ; ; 2) Exposures, i.e. current treatments with DMARDs and/or analgesics including dosing schedule and treatment onset.; 3) Patient demographics, e.g. diagnosis, age and gender, height, weight and Body Mass index (BMI); 4) Comorbidities, e.g. cardiovascular disease, diabetes and hypertension; 5) Life‐style (blood pressure, exercise habits and smoking status); Timepoint(s) of evaluation of this end point: At baseline and after 12 and 24 weeks( ± 7 days) respectively, the data are registered.; Furthermore, the effect of intervention on attention and concentration is investigated using the following cognitive test: Trail Making Test (TMT) and Digit Symbol Substitution Test (DSST). Additionally, sleep quality is evaluated with the Pitssburgh Sleep Quality Index and the expected effect for treatment is measured with Credibility/expectancy Questionnare Devilly and semistructured course interviews take place at timepoints baseline and after 12 and 24 weeks.; ; INCLUSION CRITERIA: Participants are patients diagnosed with seropositive RA, more specifically inflammatory well‐treated patients, characterized by absence of arthritis at 40 counts and normal C‐reactive protein (CRP) or with diagnosis AS in accordance with the modified New York criteria, i.e. based on physiotherapy and / or non‐steroidal anti‐inflammatory drugs (NSAIDs) and / or bDMARD inflammatory well‐treated patients, characterized by absence of axial and peripheral arthritis as well as clinically detectable entesitis, as assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS < 2.1) and where normally CRP is documented. Participant with the above mentioned diagnoses and relevant clinical status quo, followed regularly at one of the four departments are invited to participate in the study. Furthermore: a. Receiving treatment on an outpatient basis b. Diagnosed for at least 2 years c. seropositive (anti CCP and/ or IgM RF) RA, radiology (MRI an