04/02/2025
Although osteoarthritis (OA) is primarily diagnosed by structural changes in the articular cartilage, subchondral bone and ligaments, its pathology can also be observed in the surrounding joint-associated tissues, accompanied by inflammation. In progressive OA, a cytokine imbalance enhances proinflammatory cytokine levels, which subsequently induce cartilage degradation, resulting in inflammation, pain and deterioration of the joint structure. In modern medical thinking this cartilage degradation is an irreversible process. Indeed, no conventional drugs are available to date that stop or reduce cartilage degradation, improve the joint architecture or prevent or delay the progression of pathology (that is, current drug treatments are not disease modifying). Even worse, many of the currently used drugs have only modest symptomatic efficacy and carry a significant burden of serious side effects.
In this context, a randomised, placebo-controlled clinical study (n = 80, 180 days) aimed to evaluate cartilage morphology using magnetic resonance imaging (MRI), pain and joint function, and long-term safety of a Boswellia serrata gum resin extract in patients with knee osteoarthritis (KOA).
At the end of treatment, Boswellia significantly reduced symptoms (p < 0.001; vs. baseline and placebo) on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale and Lequesne's Functional Index evaluations. These effects were substantial, for example Boswellia reduced the total WOMAC score by 71%, compared to 19% for placebo. Significant and substantial improvements were also noted for the six-minute walk and stair climb tests.
Particularly noteworthy was the finding that post-trial MRI assessments of the tibiofemoral joints revealed that cartilage volume, thickness and joint space width were all increased (p < 0.001; vs. placebo) after Boswellia treatment. The inflammatory and tissue degradation markers high-sensitivity C-reactive protein (hs-CRP), matrix metalloproteinase-3, Fibulin-3, type II collagen degradation peptide in serum, and cross-linked C-terminal telopeptide of type II collagen in urine were all also significantly reduced (p < 0.001; vs. baseline and placebo). Haematology, complete serum biochemistry, urine analysis and the participants' vital signs did not alter between the groups.
The dose of Boswellia used was 100 mg per day after breakfast of an extract containing 20% AKBA (3-O-acetyl-11-keto-β-boswellic acid). The AKBA content of Boswellia serrata resin is typically around 1%, so this dose correlates to about 2 g per day of resin.
This study is the first to objectively show that treatment of KOA with Boswellia is likely to be disease modifying, a finding that has been implied by other clinical trial results for the herb.
For more information see: https://pubmed.ncbi.nlm.nih.gov/39700461/
