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Autoimmune diseases

Cannabis for Autoimmune diseases

broken shield with medical cross

Autoimmune diseases (sometimes called “autoimmune disorders”) occur when the body’s immune system attacks a part or parts of its own body, including healthy tissue. As autoimmune diseases disrupt bodily functions, they are sometimes termed “autoimmune disorders.”

Around 50 million Americans have an autoimmune disease, making it the third most prevalent disease category in the US. Due to women’s high-functioning immune systems, they are more likely to suffer from an autoimmune disease, making up to between 75% and 80% of patients.

Common symptoms of autoimmune diseases include:

  • Aching muscles
  • Difficulty concentrating
  • Hair loss
  • Fatigue
  • Low-grade fever
  • Numbness and tingling in the hands and feet
  • Skin rashes
  • Swelling and redness
  • In later stages of some autoimmune diseases, autoimmune-related encephalopathies (brain inflammation) and dementia

Some autoimmune diseases affect just one body part (e.g., myasthenia gravis, which attacks neuromuscular cells). In contrast, others affect multiple organs, like systemic lupus erythematosus, which attacks joints, skin, kidneys, brain, heart, lungs, and blood cells.

Some conditions can be autoimmune in origin, but aren’t always. These include multiple sclerosis (MS) and arthritis, which have autoimmune and non-autoimmune types.

Many cannabinoids, terpenes, and flavonoids in cannabis have anti-inflammatory and immunomodulatory properties that can help manage pain, swelling, and inflammation associated with autoimmune diseases.

Autoimmune disease causes

Both genetic and environmental factors play a part in the development of an autoimmune disease, although it does seem that there are certain commonalities between different types of autoimmune diseases. For example, an abnormality in the same gene can cause Crohn’s disease or type 1 diabetes.

Many autoimmune diseases are thought to start from a late infection of the Epstein-Barr Virus, the deficiency of CD8+ T-cells, and a predisposition toward a specific autoimmune condition on HLA class II genes, which can trigger inflammation.

Those with an autoimmune disease also have some level of dysfunction in their gut microbiome (microbial dysbiosis).Regular intake of antibiotics can lead to gut dysfunction, which increases the chance of developing an autoimmune disease. The higher prevalence of autoimmune diseases in women could also be caused by an RNA molecule called “Xist,” found only in female cells.

However, the true cause of an autoimmune disease is unknown, with certain types of infection and genetics thought to be the main cause. Still, certain environmental or dietary factors may trigger symptoms such as fatigue, rashes, joint pain, swelling, and aching (often called “flare-ups”). These include:

  • Anxiety/stress
  • Another pre-existing autoimmune disease
  • Certain medications
  • Certain viruses
  • Excessive sun exposure
  • Exposure to toxins
  • Genetics
  • Gluten
  • Injury or tissue damage
  • Specific kinds of chemicals
  • Some may find eggs, processed foods and sugars, some types of grain, nuts or seeds, legumes, caffeine, and vegetable oil trigger symptoms

Autoimmune disease symptoms and health effects

Different autoimmune diseases can display different symptoms. However, there are some common symptoms between all types of autoimmune conditions, including fatigue, muscle aches, joint pain and swelling, rashes and other skin problems, swollen glands, abdominal pain or other digestive issues, and recurring fever. Autoimmune diseases can result in the destruction of body tissue, abnormal growth of an organ, or changes in organ function.

Depending on the autoimmune condition and its severity, it can have a measurable impact on one’s quality of life (QoL) and life expectancy. Some may live full lives with little if any impact on QoL or life expectancy. Others may have severe symptoms and an aggressive enough disease to negatively impact QoL and life expectancy quite severely.

The ten most common autoimmune diseases are:

  1. Rheumatoid arthritis, where the immune system attacks the bones and joints
  2. Hashimoto’s autoimmune thyroiditis, where the immune system attacks the thyroid gland and causes hypothyroidism (elevated thyroid-stimulating hormone, or TSH, and low free thyroxine, or T4, concentrations)
  3. Celiac disease, where the immune system attacks the small intestine when a personeats gluten. It is considered an inflammatory bowel disease (IBD), like Crohn’s and colitis.
  4. Graves’ disease, where the immune system attacks the thyroid and causes it to become overactive. Unlike Hashimoto’s, Graves’ is associated with hyperthyroidism (low TSH and elevated free T4 concentrations).
  5. Diabetes mellitus, type 1, where the immune system attacks and destroys insulin-producing cells in the pancreas. This leads to high blood sugar levels, damaging blood vessels, organs, and nerves. Neuropathic (nerve) pain is a typical result of type-1 diabetes.
  6. Vitiligo (aka leucoderma), where the immune system attacks the skin’s pigment, reducing melanin production and causing white patches on the skin. Stress and anxiety can trigger further loss of pigmentation.
  7. Rheumatic fever (aka acute rheumatic fever), where the immune system attacks and inflames the body’s heart, joints, brain, and skin. Rheumatic fever usually develops due to an overreaction to a strep throat or scarlet fever infection that hasn’t been fully treated.
  8. Pernicious anemia/atrophic gastritis, where the immune system attacks the cells in the stomach. Pernicious anemia is a decrease in red blood cells when the intestines cannot properly absorb vitamin B12. Atrophic gastritis is an inflammation and weakening of the stomach, and pernicious anemia can lead to atrophic gastritis.
  9. Alopecia areata, where the immune system attacks hair follicles, causing hair loss on any body part.
  10. Immune thrombocytopenic purpura, where the immune system attacks the platelets in the blood, causing easy bruising, bleeding gums, and internal bleeding.

Other examples include Sjogren’s syndrome, Guillain-Barre syndrome, and psoriasis.

Having one autoimmune condition can increase the likelihood of developing another. Those with Lupus are more likely to suffer from rheumatoid arthritis, systemic sclerosis/scleroderma, and autoimmune hepatitis. Arthritis is also the most common extraintestinal complication of IBD.

Diagnosing an autoimmune disease

Different types of autoimmune disease may require different tests. However, some common diagnosis methods between most if not all autoimmune disorders exist, including:

  • Antinuclear antibody (ANA) tests
  • Autoantibody tests
  • Complete blood count (CBC) with white blood cell differential (CBC with WBC differential)
  • Comprehensive metabolic panel
  • C-reactive protein (CRP)
  • Erythrocyte sedimentation rate (ESR)
  • Urinalysis

Physical examinations are also likely to look at areas commonly affected by autoimmune symptoms such as joints, muscles, and skin.

Autoimmune disease prognosis

The outcome of an autoimmune disease depends on which type of autoimmune disease and its severity. Some people’s symptoms come and go, with little to no effect on their QoL or life expectancy.

However, others with more severe forms may have a reduced life expectancy. For example, the average life expectancy for females with Crohn’s is 78.4 years, and 75.5 years for males – about five to ten years less than those without an inflammatory bowel disease (IBD).

Treating autoimmune diseases

Whether severe or not, all autoimmune diseases are chronic conditions, and their symptoms can be controlled with treatment. Exercise, dietary changes (e.g., gluten-free diets), probiotic and prebiotic therapies, and physical therapy are common non-drug treatments.

Anti-inflammatory drugs, analgesics, steroids, and immunosuppressants are common drug prescriptions. Insulin injections may be necessary for type-1 diabetes.

First-line treatments

The first-line treatment depends very much on the severity of the autoimmune disease, with the most common being dietary changes, vitamin supplements, and exercise.

Common drug treatments include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may reduce the cardiovascular risk of autoimmune/auto-inflammatory diseases (but increase cardiovascular risks in the general population)
  • Corticosteroids such as prednisolone or fluticasone reduce inflammation and act as immunosuppressants
  • Analgesics such as acetaminophen (Tylenol, paracetamol), codeine (an opioid-based painkiller), and co-codamol (a mixture of acetaminophen and codeine) may be bought over the counter or prescribed to manage pain
  • Immunosuppressive drugs inhibit the activity of the immune system. Other than steroids, these include hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).

Targeted immunotherapy may also be recommended for some forms of autoimmune disease, e.g. rheumatoid arthritis, ankylosing spondylitis, and psoriasis.

Other treatments

Again, the type of treatment required depends on the severity and progression of the autoimmune disease(s) in question. For some, surgery may be required (e.g. cutting out inflamed sections of bowel tissue in an IBD).

For patients with severe, life-threatening inflammation, rituximab (a monoclonal antibody usually used for cancer treatment) may be used in combination with another second-line immunotherapy, usually cyclophosphamide. For those with MS, chemotherapy may be required. Stronger painkillers, such as tramadol, may also be prescribed.

Adjunctive and alternative treatments

Although the evidence for many alternative and adjunctive treatments for managing autoimmune disease symptoms is mixed, there are some promising therapeutic agents in this area. Some types of fungi, for example Turkey Tail, Lion’s Mane, and Reishi mushrooms, have been touted for their anxiolytic, anti-inflammatory, neuroprotective, and immunomodulatory effects.

Other adjunctive treatments include following a high-quality, stress-busting, anti-inflammatory diet (e.g. a Mediterranean diet) and incorporating herbs and spices such as turmeric, black pepper, cinnamon, and garlic.

cannabis tinctures

Cannabis for autoimmune diseases

The endocannabinoid system (ECS) plays a massive role in inflammatory responses and immune system regulation. In autoimmune disorders, the endocannabinoid system (ECS) is not functioning correctly, leading to inflammation.

Phytocannabinoids (cannabinoids derived from plants) may be of immense use for many different types of autoimmune conditions, and can help prevent the release of pro-inflammatory cytokines. These cannabis derivatives can help re-regulate the immune system and dampen inflammation.

Both THC and CBD inhibit interferon-gamma (IFN‐γ) secretion. IFN‐γ is a cytokine (a cell secreted by the immune system that affects other cells) which plays a vital role in inducing and modulating an array of immune responses. Both cannabinoid receptor type 1 (CB1 or CB1R) and receptor type 2 (CB2 or CB2R) are promising targets for managing autoimmune diseases.

Many drugs currently prescribed for treating autoimmune diseases have several side effects. These include abdominal pain, GI upset, headaches, nausea, and rashes; In the case of codeine and other opioids, addiction is also a risk. Medical cannabis has far fewer side effects by comparison.

There are many cannabinoids, terpenes, and flavonoids in cannabis that may manage inflammation and other symptoms associated with autoimmune diseases.

Cannabinoids

  • Tetrahydrocannabinol (THC) acts as an anti-inflammatory and immunosuppressant, helping to calm an overactive immune response
  • Cannabidiol (CBD) “reduces the levels of pro-inflammatory cytokines, inhibits T cell proliferation, induces T cell apoptosis, and reduces migration and adhesion of immune cells”
  • Cannabigerol (CBG) may also suppress immune function and protect from autoimmune encephalomyelitis (brain inflammation), according to mouse models
  • Cannabinol (CBN) has sedative and anti-inflammatory effects that may help manage autoimmune disorders
  • Cannabichromene (CBC) is a CB2 receptor agonist (acts on CB2 receptors) that may help stem inflammation
  • Tetrahydrocannabivarin (THCV) has anti-inflammatory effects
  • The acidic cannabinoids, tetrahydrocannabinolic acid (THCA) and cannabidiolic acid (CBDA), both have anti-inflammatory and pain-relieving effects

Terpenes

  • Beta-caryophyllene could help relieve pain and inflammation by acting on CB2 receptors in the immune system, to decrease the release of inflammatory cytokines
  • Limonene could help lift the mood and manage anxiety and depression
  • Linalool may help due to its relaxing effects
  • Myrcene could help manage insomnia due to its sedative effects
  • Pinene has antidepressant, antioxidant and antibacterial properties
  • Terpinene has anti-inflammatory properties

Flavonoids

Flavonoids in cannabis have many anti-inflammatory properties, and are a promising source of new drugs for targeting autoimmune disease-related pain and inflammation. Some flavonoids of interest include:

Additional information for patients

There are several charities focusing on specific autoimmune diseases. For example, the Crohn’s & Colitis Foundation focuses on IBD, whereas the National Organization for Rare Disorders (NORD) will focus on rarer forms of autoimmune disorder and immune-mediated conditions. For rheumatoid arthritis, there is the Rheumatoid Arthritis Foundation. As for autoimmune diseases in general, there is the worldwide charity, Autoimmune Association.

Regardless of the foundation, many will provide helplines, advocacy, awareness, and education, and other resources to those affected by autoimmune diseases. Some also provide funding for research.

different variations of CBD tinctures in bottles

Autoimmune disease FAQs

Can autoimmune diseases be cured?

Autoimmune diseases are chronic and cannot be “cured.” However, conditions can be managed, and progression slowed, by treatments like anti-inflammatory drugs and dietary changes, as well as increasing physical activity. These treatments can lead to remission of many autoimmune disease symptoms.

What are the most common autoimmune diseases?

The most common autoimmune diseases include:

  • Addison disease
  • Celiac disease – sprue (gluten-sensitive enteropathy)
  • Dermatomyositis
  • Graves disease
  • Hashimoto thyroiditis
  • Inflammatory bowel disease (Crohn disease, ulcerative colitis)
  • Multiple sclerosis (MS)
  • Myasthenia gravis
  • Pernicious anemia
  • Psoriasis
  • Reactive arthritis
  • Rheumatoid arthritis (RA)
  • Scleroderma
  • Sjögren syndrome
  • Systemic lupus erythematosus (lupus)
  • Type I diabetes

Of these, the most common autoimmune diseases are IBD (Crohn’s, ulcerative colitis), rheumatoid arthritis, and type-1 diabetes.

Do stress and anxiety cause autoimmune diseases?

Both genetic and environmental factors may cause the development of a number of autoimmune diseases, although the precise cause is unknown. Still, symptom onset in at least 50% of autoimmune disorders has been attributed to “unknown trigger factors,” and many believe that consistent stress and anxiety can lead to autoimmune diseases and/or the worsening of symptoms such as chronic pain, inflammation, and gut issues.

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