Osteoarthritis is the most common form of arthritis. It is estimated that 78 million adults above the age of 18 will be affected by arthritis and two thirds of those would be women.
Osteoarthritis involves degradation of the cartilage- the tissue that ensures better flexibility of bone joints. This leads to friction and wear and tear of the joints leading to inflammation and pain.
Osteoarthritis can affect joints like that of thumbs, fingers, neck, lower back, knee and hips. Treatment involves exercise and pain relief medications such as NSAIDs and opioids.
The current treatment available for arthritis is symptomatic based and designed to control progression of the disease but many individuals do not respond to this treatment. Active research is being conducted to identify more effective treatments and part of this focus is diverted to alternative medicine.
What is Boswellia serrata?
Boswellia serrata is a tree that grows in dry mountainous regions of India, North Africa and Middle East and it is commonly known as Indian Frankincense. There as many as 25 species belonging to the Genus Boswellia.
Three other popular forms of boswellia include: boswellia carteri, boswellia frereana and boswellia sacra. The resin obtained from Bosweliia frereana is the most expensive brand available in the market.
Salai or oleo-gum resin is obtained from the bark of Boswellia tree which is solidified and chopped to form small pieces with aromatic scent.
Prior to being used for medicinal purposes, Boswellia serrata was used as incense, fumigant and for other aromatic purposes. Even today incense sticks and powder are prepared from it.
The resin is graded based on color, shape, flavour and size. The gum resin contains 30-60% resin, 5-10% essential oils and the rest are polysaccharides. The essential oils impart the fragrance and these are also extracted for commercial purposes.
The resinous part contains monoterpenes, diterpenes, triterpenes, pentacyclic triterpenic acids (boswellic acids) and tetracyclic triterpenic acids. These are the compounds that contribute to Boswellia serrata’s medicinal value.
Traditionally Boswellia serrata is used to treat diarrhoea, dysentery, ringworm, boils, fevers (antipyretic), skin and blood diseases, cardiovascular diseases, mouth sores, bad throat, bronchitis, asthma, cough, vaginal discharges, hair-loss, jaundice, hemorrhoids, syphilitic diseases, irregular menses and stimulation of liver.
How does Boswellia serrata help in osteoarthritis?
Current research proves that Boswellia serrata possesses pharmacological properties like anti-arthritic, anti-inflammatory, analgesic, hepatoprotective etc and this could offer relief in osteoarthritis.
1. Boswellia serrata reduces osteoarthritis symptoms in 7 days
Kimmatkar et. al have the studied the effect of standardized extract of boswellia serrata on knee osteoarthritis in 2003. The preparation contained 65% organic acids and 40% Boswellic acid (trade name WokVel).
The study lasted for 8 weeks and dose was 333mg thrice a day. A decrease in knee pain, increased knee flexibility, increased walking distance and ability to climb stairs was reported but the symptoms returned on cessation of the treatment.
A clinical trial was conducted to assess the efficacy of 5-Loxin in knee osteoarthritis. This was published in 2008. 5-Loxin is a specialized extract of Boswellia serrata which contains 30% AKBA and inhibits the activity of 5-lipooxygenase enzyme to curb inflammation.
75 patients participated in the study and received 100 or 250 mg of 5-Loxin for 3 months. 250mg dosage was more effective than 100mg, Improvement in pain score and joint function was seen as early as 7 days with 250mg dose.
Additionally a reduction in enzyme MMP-3 in the fluid lubricating the joints was observed. This enzyme is responsible for cartilage degradation. Overall 5-Loxin reduces inflammation, relieves pain, improves joint function and reduces bone degradation in osteoarthritis with effects visible within 7 days.
Aflapin is another formulation of Boswellia serrata. It is a novel synergestic compound obtained from resin of Boswellia serrata (enriched with AKBA and non volatile oil).
The bioavailability of AKBA- a strong boswellic acid is better in Aflapin than 5-Loxin. Bioavailabilty is absorption and distribution of a compound in the body.
Additionally it has better anti-inflammatory action than 5-Loxin. In a study (year 2011) comparing the effects of the two formulation on knee osteoarthritis improvement in pain score and joint function was seen as early as 7 days with 100mg Aflapin.
Both formulations were safe and effective for osteoarthritis but Aflapin was found more effective than 5-Loxin.
Vishal et. al report that 100mg Aflapin reduces pain and improves joint function in osteoarthritis as early as 5 days.
Boswellia serrata is marketed under the name Shallaki by Himalaya Drug Company. A dose of 6g per day in combination with Shallaki cream was found to reduce the symptoms in the course of 2 months.
What does this mean?
Bioavailable forms of Boswellia serrata extracts-Aflapin and 5-Loxin attenuate osteoarthritis symptoms as early as 7 days. Research suggests that Aflapin is faster acting than 5-Loxin. Topical application of Boswellia also hastens improvement.
2. It is an anti-inflammatory agent
M.Z. Siddiqui in his paper ‘Boswellia Serrata, A Potential Anti-inflammatory Agent: An Overview’ speaks about how this herb exerts its anti-inflammatory property in a unique manner compared to other herbs and medicines.
Boswellic acids present in the resinous part are the compounds are responsible for its anti-inflammatory action. Most herbs and anti-inflammatory drugs reduced inflammation by inhibiting the activity of enzyme COX.
Boswellic acids, on the other hand, inhibit formation of leukotrienes (pro-inflammatory agent) by inhibiting the action of inflammatory enzyme LOX. It also inhibits the activity of enzyme human leukocyte elastase which triggers inflammation by damaging tissues.
This dual action is unique to boswellic acids. The most potent inhibitor of LOX among the boswellic acids is AKBA or 3-acetyl-11-keto-β-boswellic acid.
In an animal model, boswellic acids have demonstrated 45-67% anti-arthritic activity due to its anti-inflammatory action. In another experimental model of anti-inflammatory activity boswellic acids showed 35% inhibition of inflammation and its mechanism of action was unlike aspirin or steroids.
Incensole acetate, a novel anti-inflammatory compound present in the resin inhibits the activity of main protein controlling inflammation-nuclear factor kappa B.
Inhibition of other enzymes have also been reported which contribute to its anti-inflammatory effect and research suggests that boswellia serrata could be an alternative to NSAIDs (non steroidal anti-inflammatory drugs).
Results of a clinical trial indicate that Boswellia extract is more effective than valdecoxib (anti-inflammatory drug that inhibits COX enzyme) in knee osteoarthritis. Boswellia is slow acting but its therapeutic effects are persistent even after stopping the therapy unlike valdecoxib.
What does this mean?
Boswellia serrata has a unique way of reducing inflammation. It inhibits the activity of LOX enzyme which is involved in inflammation unlike other agents which act on COX enzyme (inflammatory enzyme).
Research shows that its anti-inflammatory effect is more persistent than that of a conventional medicine that inhibits COX enzyme.
3. It reduces pain fast
FlexiQule ( a standardized Boswellia extract) in combination with standard treatment in symptomatic knee osteoarthritis is found to reduce pain and stiffness within 4 weeks.
Belcaro et. al studied the therapeutic efficacy of FlexiQule in hand ‘stress’ arthritis. Within 2 weeks of supplementation there was a marked reduction in pain.
No patient that received Boswellia supplement needed to take medications while the control group had to consume NSAIDs and steroids to reduce pain.
Indian researchers have studied the analgesic or pain relieving property of Shallaki, a standardized extract of Boswellia in humans. 250mg of Shallaki is found to reduce pain and increase pain bearing threshold in mechanical pain model in humans.
What does this mean?
Boswellia serrata has fast acting pain relieving property that can benefit in osteoarthritis.
4. It prevents wearing off of bone tissue
Sumantran et. al describe the effect of a herbal formulation containing Boswellia serrata on cartilage of knee osteoarthritis patients. This formulation demonstrated anti-inflammatory effect and protected cartilage from degradation.
Boswellia serrata present in this formulation is said to be responsible for this chondroprotective( protecting bone tissue) and anti-inflammatory effect.
Both Aflapin and 5-Loxin have bone protective properties ; but the inhibitory potential of Aflapin against MMP-3 (enzyme that degrades cartilage) is 14.83% better than 5-Loxin.
A herbal formulation containing Boswellia serrata and leucine (amino acid that build protein) is found to have chondroprotective action. It not only protects bone tissue but also aid in repair and regeneration.
What does this mean?
Apart from controlling inflammation, Boswellia serrata has chondroprotective property- it protects bone and cartilage from degrading which is the major feature of osteoarthritis.
5. Topical application of Boswellia serrata benefits in arthritis
Singh et. al have reported that Boswellia serrata exerts anti-inflammatory effect even via topical application. It aids in reducing swelling and arthritis in animal model.
Another animal study reports that topical treatment results in 2-6 folds higher concentration of boswellic acids in synovial fluid- fluid that lubricates joint and ensures smooth joint function.
Additionally topical treatment also protects cartilage and bone tissue.
What does this mean?
Topical application of Boswellia serrata also helps in controlling inflammation and protecting bone tissue from damage.
6. It works in combination with other herbs and medicines to treat osteoarthritis
500mg of a combined formulation of turmeric and boswellia serrata administered twice a day is found to be more effective than 100mg celecoxib twice a day in osteoarthritis. Celecoxib is a medicine prescribed in treating arthritis and it inhibits the activity of inflammatory enzyme-COX.
Boswellia serrata in combination with ginger and other herbs shows potential anti-arthritic and bone protective properties.
A 6 month study involving 440 osteoarthritis patients demonstrated that an Ayurvedic formulation containing Boswellia serrata showed therapeutic efficacy equivalent to glucosamine and celecoxib.
Celecoxib are anti-inflammatory medicine and dietary supplement respectively used in arthritis treatment.
Boswellic acids may show synergistic activity with glucosamine in arthritis. Combination of methysulfonylmethane and boswellic acids is as effective as glucosamine in treating arthritis.
Diarecin is a slow acting drug of class anthroquinone used to treat osteoarthritis. Boswellic acids boost the anti-arthritic effect of diarecin.
What does this mean?
Boswellia serrata extracts are better than celecoxib (anti-arthritic drug) in treating osteoarthritis. Boswellia has therapeutic efficacy equivalent to that of glucosamine and works synergistically with it.
Boswellia serrata can be taken as capsule, tablet or bark decoction. If using the resin directly the daily dose is in the range of 2400-2600mg in divided doses.
In case of supplements you have to look for high quality encapsulated powder and check if its a standardized extract and the % of boswellic acids. % of boswellic acids is in the range of 35-65%.
Boswellia serrata is available under various brand names such as Boswellin, Shalaki, 5-Loxin, Aflapin, AprèsFLEX etc. and they have high concentrations of active ingredients. The dosage is somewhere around 100-250 mg daily.
Essential oils of Boswellia are available that can be taken internally or applied topically when mixed with a carrier oil. Conduct a patch test prior.
Cream based formulations of boswellia serrata are also available which can be applied topically for relief.
Consult a health practitioner before taking Boswellia serrata supplements.
No significant side effects with Boswellia serrata have been reported. Slight gastric discomfort is possible initially.
Boswellia serrata should not be consumed during pregnancy or lactation since it can lead to birth related problems or cause abortion.
It may have drug interactions with non steroidal anti-inflammatory drugs. Its best to consult to a doctor or herbalist before taking boswellia serrata. Boswellic acids have anti-coagulant property; caution to be exercised if already on blood thinners.
The active ingredients of Boswellia serrata have unique anti-inflammatory action. Also the herb protects bone tissue making it even more effective in osteoarthritis.
There is compelling evidence in case of Boswellia serrata’s utility in osteoarthritis and it is definitely one herbal supplement that must be considered as part of treatment in arthritis.