Is Boswellia helpful for arthritis?

Boswellia (Boswellia serrata) is an herb that has been used in Ayurvedic medicine. Its gum resin is felt to have anti-inflammatory, anti-arthritic, and analgesic activities. Researchers at the Government Medical College in Nagpur, India conducted a study of Boswellia extract in patients with osteoarthritis (OA) of the knee.

The study was conducted primarily to see if alternative therapies were available that might be safer substitutes for anti-inflammatory drugs such as COX-2 inhibitors. The study was a randomized, prospective and open label trial which enrolled 66 patients ages 40 to 70 years, with a diagnosis of osteoarthritis of the knee. Patients were divided into two groups and assigned to receive one of two treatments: one receiving 333mg of Boswellia serrata extract (BSE) three-times a day, and the other 10mg of valdecoxib (Bextra) once a day. The patients were assessed clinically using the WOMAC (Western Ontario and McMaster University Osteoarthritis Index) scale to assess function each month over the six-month intervention period, and once more at the end of the seventh month.

The researchers found that in the valdecoxib group a statistically significant improvement was seen within the first month, but the effects stopped as soon as the drug was discontinued. For the Boswellia group, a statistically significant improvement was seen after two months, but the effect was still in evidence even at the end of the study. The researchers commented, "BSE showed a slower onset of action but the effect persisted even after stopping therapy, while the action of vadecoxib became evident faster but waned rapidly after stopping treatment." Adverse events included one patient who dropped from the BSE group due to diarrhea.

No serious adverse events were reported for valdecoxib group during the study. However, the drug has since been removed from the U.S. by the manufacturer (Pfizer) at the request of the FDA.

The conclusion of the authors: "In terms of safety, efficacy and duration of action, the present study shows that BSE was superior to valdecoxib, except for the slower onset of action compared to valdecoxib." [Sontakke S, Thawani V, Pimpalkhute S, Kabra P, Babhulkar S, Hingorani L. Open, randomized, controlled clinical trial of Boswellia serrata extract as compared to valdecoxib in osteoarthritis of knee. Indian Journal of Pharmacology. 2007; 39 (1): 27-29]Author’s note: Many patients are searching for safer alternatives to currently available non-steroidal anti-inflammatory drugs for arthritis. Safety must be matched with efficacy though. While the information on Boswellia is encouraging, more research is necessary.