Can Cannabidiol (CBD) Help Treat Autoimmune Disease?
Autoimmune diseases (AD) include over 80 diagnoses. The prevailing understanding is that AD etiology is unknown; therefore, therapies target immunosuppression and symptom reduction. Due to multiple side effects, researchers are exploring other therapies.
In a recent review, cannabidiol (CBD), a non-psychoactive constituent from the Cannabis sativa plant, was found to be one of the main modulators of the immune response.1 Through impeding inflammatory cytokine production and modulating the immune response, CBD can significantly benefit autoimmune diseases, especially multiple sclerosis (MS), rheumatoid arthritis (RA), and inflammatory bowel disease (IBD).
CBD and the Endocannabinoid System (ECS)
The endocannabinoid system (ECS) consists of cannabinoid receptors throughout the body as well as endogenous ligands (endocannabinoids) that regulate multiple functions. Exogenous ligands such as CBD can also bind to these receptors, exerting an effect. In human immune cell models and animal models, CBD interacts with the ECS receptors, resulting in decreased secretion of proinflammatory cytokines and a balanced immune response.1 Its immunomodulating effects include T cell activity regulation, macrophage apoptosis, proinflammatory cytokine suppression, and signaling pathway modulation for inflammation and immune homeostasis.2
CBD has anti-inflammatory, neuroprotective, anticonvulsant, muscle relaxant, antioxidant, and anti-psychotropic effects.3 Unlike tetrahydrocannabinol (THC), the main Cannabis constituent responsible for the high feeling, CBD does not have this effect. These properties make CBD an attractive therapy for autoimmune diseases. Many autoimmune disease patients use Cannabis and/or CBD, finding it effective in managing symptoms.4-6
Multiple Sclerosis (MS)
Endocannabinoid levels were measured in the cerebrospinal fluid of 50 patients with MS and 20 control participants. Patients with MS had significantly reduced endocannabinoid levels compared to the control group, suggesting an impaired ECS in MS. In relapsing patients, levels of endocannabinoids were higher, suggesting their role in neuroprotection.7
Numerous trials have shown benefit with Sativex® (Nabiximols), a synthetic form of THC:CBD in a 1:1 ratio approved to treat spasticity in MS.3,8 One small study assessed THC oil, CBD oil, alone and in combination, and spasticity and pain decreased, although clinical studies with more people are needed to confirm whether CBD alone is effective.8,9 Clinical trials are currently underway assessing the efficacy of CBD as a complementary treatment for multiple sclerosis.10-12
Rheumatoid Arthritis (RA)
RA is characterized by severe, progressive synovitis and rapid destruction of the joint. The ECS regulates inflammation and nociception in synovial joints.4,13 In preclinical models, CBD reduces pain, disease severity, and inflammatory cytokines.14
In a survey on arthritis, individuals with RA and other autoimmune arthritis reported using CBD for pain and symptom relief. The majority reported improved pain, physical function, and sleep, and more pronounced benefits with longer use. Many respondents were also able to discontinue other pain medications as a result.4
In a 12-week pilot randomized controlled trial, RA patients with moderate to severe disease activity took either oral CBD (200 mg BID or 400 mg BID) or placebo. CBD did not reduce RA disease activity, as measured by clinical evaluations or imaging studies. However, there was an improvement in subjective pain using a visual analog scale between the CBD 200 mg BID group versus the placebo group. More people withdrew from the CBD 400 mg BID group due to adverse effects, including GI side effects.15 Future studies using different formulations may help determine effective dosing.
Inflammatory Bowel Disease (IBD)
CBD was studied in a randomized controlled trial in 39 patients with ulcerative colitis (UC). Patients were started on a 50 mg CBD-rich botanical extract twice daily with a 2-week dose escalation up to 250 mg twice daily. Capsules were not purified and contained up to 4.7% THC, which may account for the increased adverse events seen in the CBD group versus placebo. Remission rates were similar for CBD and placebo. However, symptom improvement and patient-reported quality of life were greater in the CBD group. Although not statistically significant, improved rectal bleeding and endoscopy scores were observed in the CBD group. The placebo group had adverse events suggestive of worsening colitis.16
Another 8-week study on Crohn’s disease patients showed similar effects, with significant clinical and quality of life improvements, but improvements in inflammatory parameters and endoscopic scores not reaching clinical significance. In this study, a CBD/THC oil was used with one drop containing approximately 8 mg CBD and 2 mg THC. Doses were titrated up from 1 drop BID to a maximal dose of 20 drops BID.17
Both studies included THC in the study formula; more studies are needed to determine if CBD alone is effective. A study on 19 Crohn’s patients showed that 10 mg CBD BID was safe, but not effective, likely due to the lower dose.18
CBD: A Promising Adjunct for Autoimmune Disease
Because of its extensive actions, especially as an immunomodulator, CBD is emerging as a safe adjunctive therapy for treating autoimmune diseases. Preclinical and clinical studies show improvements in MS, RA, and IBD, and research is ongoing for other autoimmune diseases.2 Continued research will be essential to determine optimal dosing regimens and to further clarify CBD’s therapeutic role in autoimmune treatment regimens.
References:
1. Rodríguez Mesa XM, Moreno Vergara AF, Contreras Bolaños LA, Guevara Moriones N, Mejía Piñeros AL, Santander González SP. Therapeutic Prospects of Cannabinoids in the Immunomodulation of Prevalent Autoimmune Diseases. Cannabis and cannabinoid research. 2021;6(3):196-210.
2. Mujahid K, Rasheed MS, Sabir A, et al. Cannabidiol as an immune modulator: A comprehensive review. Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society. 2025;33(3):11.
3. Zettl UK, Rommer P, Hipp P, Patejdl R. Evidence for the efficacy and effectiveness of THC-CBD oromucosal spray in symptom management of patients with spasticity due to multiple sclerosis. Therapeutic advances in neurological disorders. 2016;9(1):9-30.
4. Frane N, Stapleton E, Iturriaga C, Ganz M, Rasquinha V, Duarte R. Cannabidiol as a treatment for arthritis and joint pain: an exploratory cross-sectional study. Journal of cannabis research. 2022;4(1):47.
5. Santarossa TM, So R, Smyth DP, Gustavsen DS, Tsuyuki DRT. Medical cannabis use in Canadians with multiple sclerosis. Multiple sclerosis and related disorders. 2022;59:103638.
6. Lal S, Prasad N, Ryan M, et al. Cannabis use amongst patients with inflammatory bowel disease. European journal of gastroenterology & hepatology. 2011;23(10):891-896.
7. Di Filippo M, Pini LA, Pelliccioli GP, Calabresi P, Sarchielli P. Abnormalities in the cerebrospinal fluid levels of endocannabinoids in multiple sclerosis. Journal of neurology, neurosurgery, and psychiatry. 2008;79(11):1224-1229.
8. Azadvari M, Pourshams M, Guitynavard F, et al. Cannabinoids for spasticity in patients with multiple sclerosis: A systematic review and meta-analysis. Multiple sclerosis journal - experimental, translational and clinical. 2024;10(4):20552173241282379.
9. S G, Hb S, K L, et al. Safety and efficacy of low-dose medical cannabis oils in multiple sclerosis. Multiple sclerosis and related disorders. 2021;48:102708.
10. Zertal A, Alami Marrouni K, Arbour N, et al. Efficacy of cannabinoids compared to the current standard treatments on symptom relief in persons with multiple sclerosis (CANSEP trial): study protocol for a randomized clinical trial. Front Neurol. 2024;15:1440678.
11. NIH. Multiple Sclerosis and CBD. 2025; www.clinicaltrials.gov.
12. Hansen JS, Hansen RM, Petersen T, et al. The Effect of Cannabis-Based Medicine on Neuropathic Pain and Spasticity in Patients with Multiple Sclerosis and Spinal Cord Injury: Study Protocol of a National Multicenter Double-Blinded, Placebo-Controlled Trial. Brain sciences. 2021;11(9).
13. Richardson D, Pearson RG, Kurian N, et al. Characterisation of the cannabinoid receptor system in synovial tissue and fluid in patients with osteoarthritis and rheumatoid arthritis. Arthritis research & therapy. 2008;10(2):R43.
14. Lowin T, Tingting R, Zurmahr J, Classen T, Schneider M, Pongratz G. Cannabidiol (CBD): a killer for inflammatory rheumatoid arthritis synovial fibroblasts. Cell death & disease. 2020;11(8):714.
15. Ranganath V, Wilhalme H, Morris N, et al. Safety and Efficacy of Cannabidiol in Rheumatoid Arthritis Patients: A Phase 1B Pilot Randomized Placebo Controlled Trial. Arthritis & Rheumatology. 2024;76:4520-4521.
16. Irving PM, Iqbal T, Nwokolo C, et al. A Randomized, Double-blind, Placebo-controlled, Parallel-group, Pilot Study of Cannabidiol-rich Botanical Extract in the Symptomatic Treatment of Ulcerative Colitis. Inflammatory bowel diseases. 2018;24(4):714-724.
17. Naftali T, Bar-Lev Schleider L, Almog S, Meiri D, Konikoff FM. Oral CBD-rich Cannabis Induces Clinical but Not Endoscopic Response in Patients with Crohn's Disease, a Randomised Controlled Trial. Journal of Crohn's & colitis. 2021;15(11):1799-1806.
18. Naftali T, Mechulam R, Marii A, et al. Low-Dose Cannabidiol Is Safe but Not Effective in the Treatment for Crohn's Disease, a Randomized Controlled Trial. Digestive diseases and sciences. 2017;62(6):1615-1620.
