Boswellia for Osteoarthritis
Updated September 03, 2013.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Boswellia is a tree that originates in India. The extract derived from the gum resin of the bark of the Boswellia tree is thought to have some health benefits. Boswellia is classified as an ayurvedic herb. It is also referred to as Indian frankincense.
Boswellia is thought to have anti-inflammatory and analgesic (pain-relieving) properties.
There is good, but not strong scientific evidence for the use of Boswellia to treat chronic asthma and cancer. There is unclear scientific evidence for its use to treat rheumatoid arthritis, osteoarthritis, ulcerative colitis, and Crohn's disease. Overall, evidence to support its beneficial effects is scant.
Boswellia is available as a capsule or pill. The usual recommended dose is 300 mg. to 400 mg., three times a day. However, safe dosing of Boswellia has not been well-studied. It has been recommended that for those who choose to use Boswellia, a product that contains 60% boswellic acid should be selected.
In 2003, a randomized, placebo-controlled, crossover study evaluated the safety, effectiveness, and tolerability of Boswellia serrata extract in 30 knee osteoarthritis patients. Results published in Phytomedicine revealed that 15 of the patients received Boswellia, while the other 15 received placebo for 8 weeks.
After the first assessment occurred at 8 weeks, the groups had a washout period (the time it takes for the body to completely clear a treatment). For the next 8 weeks, the patients crossed over to receive the opposite of what they were given the first 8 weeks. Patients given Boswellia all reported a decrease in knee pain, increased knee flexion, and increased walking distance. Joint swelling decreased. There was no apparent change on x-rays.
In 2007, researchers published results in the Indian Journal of Pharmacology from a 6-month randomized, prospective, open-label, comparative study that assessed the effectiveness, safety and tolerability of Boswellia serrata extract compared to valdecoxib (brand name Bextra, removed from market in U.S. in 2005) in 66 patients with knee osteoarthritis. Pain, stiffness, and difficulty in performing daily activities improved significantly within two months of treatment with Boswellia and the improvement lasted until one month after stopping the treatment. There was significant improvement in patients treated with valdecoxib after one month of treatment, but the beneficial effect did not continue after treatment was stopped.
In 2008, there was a study involving 5-Loxin, a Boswellia serrata extract that is enriched with 30% 3-O-acetyl-11-keto-beta-boswellic acid. There were 75 patients involved in the 90-day study, according to results published in Arthritis Research Therapy. In the 90-day period, patients either received 100 mg. or 250 mg. of 5-Loxin or placebo. 5-Loxin was found to reduce pain and improve physical function in the knee osteoarthritis patients.
In 2010, 5-Loxin and Aflapin, both derived from Boswellia serrata, were compared for knee osteoarthritis. There were 60 osteoarthritis patients in the study, published in the International Journal of Medical Sciences. Patients received either 100 mg. 5-Loxin or 100 mg. Aflapin or placebo for 90 days. Both 5-Loxin and Aflapin improved pain and physical function significantly.
In 2011, results from a 30-day trial which assessed the effectiveness of Aflapin for managing symptoms of osteoarthritis were published in the International Journal of Medical Sciences. There were 60 study participants who received either 100 mg. Aflapin or placebo. Aflapin was found to significantly improve pain and physical function, in as few as 5 days.
People who have a known allergy to Boswellia should avoid products that contain it or members of the Burseraceae family. Generally, Boswellia is considered safe when used as directed, unless there is a known allergy. Some side effects that turned up in studies include nausea and acid reflux. However, the safety and toxicity of Boswellia is not considered well-studied. Dermatitis also occurred in clinical trials of a product that contained Boswellia serrata, but it could have been due to other ingredients.
The safe use of Boswellia during pregnancy has not been studied, therefore it is not recommended for pregnant women. Boswellia has also not been studied in children.
If you are considering the use of Boswellia, as with any treatment, be sure to talk to your doctor first.
Sources:
Supplement Guide: Indian Frankincense. Arthritis Today. Accessed 02/20/2013.
http://www.arthritistoday.org/treatments/supplement-guide/supplements/indian-frankincense.php
Boswellia (Boswellia serrata). Natural Medicine A-Z. Accessed 02/20/2013.
Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee - a randomized double blind placebo controlled trial. Kimmatkar N. et al. Phytomedicine. January 2003.
http://www.ncbi.nlm.nih.gov/pubmed/12622457
Open, randomized, controlled clinical trial of Boswellia serrata extract as compared to valdecoxib in osteoarthritis of knee. Sontakke S et al. Indian Journal of Pharmacology. 2007;39:27-9.
http://www.ijp-online.com/article.asp?issn=0253-7613;year=2007;volume=39;issue=1;spage=27;epage=29;aulast=Sontakke
A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Research Therapy. July 2008.
http://www.ncbi.nlm.nih.gov/pubmed/18667054
Comparative efficacy and tolerability of 5-Loxin ad Aflapin against osteoarthritis of the knee: a double blind randomized, placebo, controlled clinical study.
Sengupta K et al. International Journal of Medical Sciences. November, 2010.
http://www.ncbi.nlm.nih.gov/pubmed/?term=comparative+efficacy+5-Loxin+and+Aflapin
A double blind, randomized, placebo controlled clinical study evaluates the early efficacy of Aflapin in subjects with osteoarthritis of the knee. Vishall AA et al. International Journal of Medical Sciences. October 12, 2011.
http://www.ncbi.nlm.nih.gov/pubmed/22022214
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
What Is Boswellia?
Boswellia is a tree that originates in India. The extract derived from the gum resin of the bark of the Boswellia tree is thought to have some health benefits. Boswellia is classified as an ayurvedic herb. It is also referred to as Indian frankincense.
What Are the Health Benefits of Boswellia?
Boswellia is thought to have anti-inflammatory and analgesic (pain-relieving) properties.
There is good, but not strong scientific evidence for the use of Boswellia to treat chronic asthma and cancer. There is unclear scientific evidence for its use to treat rheumatoid arthritis, osteoarthritis, ulcerative colitis, and Crohn's disease. Overall, evidence to support its beneficial effects is scant.
What Is the Availability of Boswellia?
Boswellia is available as a capsule or pill. The usual recommended dose is 300 mg. to 400 mg., three times a day. However, safe dosing of Boswellia has not been well-studied. It has been recommended that for those who choose to use Boswellia, a product that contains 60% boswellic acid should be selected.
Studies That Support the Benefits of Boswellia
In 2003, a randomized, placebo-controlled, crossover study evaluated the safety, effectiveness, and tolerability of Boswellia serrata extract in 30 knee osteoarthritis patients. Results published in Phytomedicine revealed that 15 of the patients received Boswellia, while the other 15 received placebo for 8 weeks.
After the first assessment occurred at 8 weeks, the groups had a washout period (the time it takes for the body to completely clear a treatment). For the next 8 weeks, the patients crossed over to receive the opposite of what they were given the first 8 weeks. Patients given Boswellia all reported a decrease in knee pain, increased knee flexion, and increased walking distance. Joint swelling decreased. There was no apparent change on x-rays.
In 2007, researchers published results in the Indian Journal of Pharmacology from a 6-month randomized, prospective, open-label, comparative study that assessed the effectiveness, safety and tolerability of Boswellia serrata extract compared to valdecoxib (brand name Bextra, removed from market in U.S. in 2005) in 66 patients with knee osteoarthritis. Pain, stiffness, and difficulty in performing daily activities improved significantly within two months of treatment with Boswellia and the improvement lasted until one month after stopping the treatment. There was significant improvement in patients treated with valdecoxib after one month of treatment, but the beneficial effect did not continue after treatment was stopped.
In 2008, there was a study involving 5-Loxin, a Boswellia serrata extract that is enriched with 30% 3-O-acetyl-11-keto-beta-boswellic acid. There were 75 patients involved in the 90-day study, according to results published in Arthritis Research Therapy. In the 90-day period, patients either received 100 mg. or 250 mg. of 5-Loxin or placebo. 5-Loxin was found to reduce pain and improve physical function in the knee osteoarthritis patients.
In 2010, 5-Loxin and Aflapin, both derived from Boswellia serrata, were compared for knee osteoarthritis. There were 60 osteoarthritis patients in the study, published in the International Journal of Medical Sciences. Patients received either 100 mg. 5-Loxin or 100 mg. Aflapin or placebo for 90 days. Both 5-Loxin and Aflapin improved pain and physical function significantly.
In 2011, results from a 30-day trial which assessed the effectiveness of Aflapin for managing symptoms of osteoarthritis were published in the International Journal of Medical Sciences. There were 60 study participants who received either 100 mg. Aflapin or placebo. Aflapin was found to significantly improve pain and physical function, in as few as 5 days.
Side Effects, Warnings, and Contraindications for Boswellia
People who have a known allergy to Boswellia should avoid products that contain it or members of the Burseraceae family. Generally, Boswellia is considered safe when used as directed, unless there is a known allergy. Some side effects that turned up in studies include nausea and acid reflux. However, the safety and toxicity of Boswellia is not considered well-studied. Dermatitis also occurred in clinical trials of a product that contained Boswellia serrata, but it could have been due to other ingredients.
The safe use of Boswellia during pregnancy has not been studied, therefore it is not recommended for pregnant women. Boswellia has also not been studied in children.
If you are considering the use of Boswellia, as with any treatment, be sure to talk to your doctor first.
Sources:
Supplement Guide: Indian Frankincense. Arthritis Today. Accessed 02/20/2013.
http://www.arthritistoday.org/treatments/supplement-guide/supplements/indian-frankincense.php
Boswellia (Boswellia serrata). Natural Medicine A-Z. Accessed 02/20/2013.
Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee - a randomized double blind placebo controlled trial. Kimmatkar N. et al. Phytomedicine. January 2003.
http://www.ncbi.nlm.nih.gov/pubmed/12622457
Open, randomized, controlled clinical trial of Boswellia serrata extract as compared to valdecoxib in osteoarthritis of knee. Sontakke S et al. Indian Journal of Pharmacology. 2007;39:27-9.
http://www.ijp-online.com/article.asp?issn=0253-7613;year=2007;volume=39;issue=1;spage=27;epage=29;aulast=Sontakke
A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Research Therapy. July 2008.
http://www.ncbi.nlm.nih.gov/pubmed/18667054
Comparative efficacy and tolerability of 5-Loxin ad Aflapin against osteoarthritis of the knee: a double blind randomized, placebo, controlled clinical study.
Sengupta K et al. International Journal of Medical Sciences. November, 2010.
http://www.ncbi.nlm.nih.gov/pubmed/?term=comparative+efficacy+5-Loxin+and+Aflapin
A double blind, randomized, placebo controlled clinical study evaluates the early efficacy of Aflapin in subjects with osteoarthritis of the knee. Vishall AA et al. International Journal of Medical Sciences. October 12, 2011.
http://www.ncbi.nlm.nih.gov/pubmed/22022214
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