Rheumatoid arthritis and CBD
Rheumatoid arthritis and CBD
Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease affecting approximately one percent of the population worldwide. It is more common in women and people in their fifties but can occur at any age [1]. Researchers aren’t sure exactly what causes RA, but the leading hypothesis is that some people are genetically susceptible to some external factors [2]. The disease initially affects small joints, progresses to larger ones, and may even affect internal organs, the most frequent being the lungs and the heart. If it does affect organs, it can lead to diseases such as interstitial lung disease, pleural effusion, bronchiectasis, and pericarditis [1]. Since there is currently no cure for RA, therapies aim to reduce inflammation in the joints, relieve pain, and generally slow down the damaging process [3]. Advances in recent decades have been able to slow the progress of the disease and significantly improve patients’ long-term prognosis [4],[5],[6]. This is due to earlier diagnosis, aggressive treatment before the onset of irreversible joint damage, and the use of disease-modifying antirheumatic drugs (DMARDs)[7]. One drug, in particular, Methotrexate, often serves as first-line therapy (along with folic acid) [8] or in combination with other DMARDs. Non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids are also used to relieve pain and stiffness. Yet these come with long-term risks, including cardiovascular, renal, and gastrointestinal complications, higher risk for infections, hypertension, hyperglycemia, and osteoporosis [1].

CBD and rheumatoid arthritis
In addition to providing an alternative to NSAIDs for chronic pain relief, CBD may help with other arthritis symptoms. While the effects of CBD on inflammation have only been studied on animal models [9], it looks likely that CBD can relieve arthritis by targeting synovial fibroblasts in inflammatory conditions [10]. CBD desensitizes and therefore inhibits the nociceptors TRPV1 and TRPA1, thereby promoting anti-inflammation in immune cells and reducing the transmission of pain to sensory nerves [11]. CBD could also increase the efficacy of already used anti-rheumatic drugs [10]. It can be used systemically (when taken orally) or topically with the application of CBD oil to the swollen joints.
Dosing recommendations for patients with rheumatiod arthritis

Is CBD safe?

Yes. CBD is considered safe for rheumatoid arthritis. 

What is the recommended daily dose? 

Start with 1 mg/kg/day and titrate to effect
- possibly as high as
20 mg/kg/day. Read General recommendations.

Should I take it before or after a meal? 

CBD should be taken during, or after a meal. 

How many times a day should I take CBD? 

Take your dose twice
a day. Half of it in the morning and the other half in the evening. 

Are there any known drug interactions? 

Some. Read Side effects for more information.


1. Sparks JA: Rheumatoid Arthritis. Annals of internal medicine 170: Itc1-itc16, 2019. 

2. Gibofsky A, Winchester RJ, Patarroyo M, Fotino M and Kunkel HG: Disease associations of the Ia-like human alloantigens. Contrasting patterns in rheumatoid arthritis and systemic lupus erythematosus. The Journal of experimental medicine 148: 1728-1732, 1978. 

3. Bullock J, Rizvi SAA, Saleh AM, et al: Rheumatoid Arthritis: A Brief Overview of the Treatment. Med Princ Pract 27: 501-507, 2018. 

4. Lacaille D, Avina-Zubieta JA, Sayre EC and Abrahamowicz M: Improvement in 5-year mortality in incident rheumatoid arthritis compared with the general population-closing the mortality gap. Annals of the rheumatic diseases 76: 1057-1063, 2017. 

5. Markusse IM, Akdemir G, Dirven L, et al: Long-Term Outcomes of Patients With Recent-Onset Rheumatoid Arthritis After 10 Years of Tight Controlled Treatment: A Randomized Trial. Annals of internal medicine 164: 523-531, 2016. 

6. Zhang Y, Lu N, Peloquin C, et al: Improved survival in rheumatoid arthritis: a general population-based cohort study. Annals of the rheumatic diseases 76: 408-413, 2017. 

7. Carpenter L, Norton S, Nikiphorou E, et al: Reductions in Radiographic Progression in Early Rheumatoid Arthritis Over Twenty-Five Years: Changing Contribution From Rheumatoid Factor in Two Multicenter UK Inception Cohorts. Arthritis care & research 69: 1809-1817, 2017. 

8. Visser K, Katchamart W, Loza E, et al: Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Annals of the rheumatic diseases 68: 1086-1093, 2009. 

9. Burstein S: Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorganic & medicinal chemistry 23: 1377-1385, 2015. 

10. Lowin T, Tingting R, Zurmahr J, Classen T, Schneider M and Pongratz G: Cannabidiol (CBD): a killer for inflammatory rheumatoid arthritis synovial fibroblasts. Cell Death & Disease 11: 714, 2020.

11. Lowin T, Schneider M and Pongratz G: Joints for joints: cannabinoids in the treatment of rheumatoid arthritis. Current opinion in rheumatology 31: 271-278, 2019.