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• Boswellia for Arthritis

Common Names: Indian frankincense

Scientific Names: Boswellia serrata

What is Boswellia?

• Boswellia is a group of flowering plants, found in tropical areas of Africa and Asia. The specific species Boswellia serrata is a tree found in India and has various medicinal properties.

What it is it used for in people with rheumatic conditions?

• Boswellia has been used for the management of osteoarthritis (OA) to reduce joint pain and improve function.
• There have been studies in patients with rheumatoid arthritis with conflicting results and more research is required.

How is it thought to work?

• The gum resin that is taken from the bark of the boswellia tree contains substances (boswellic acids), which seem to have anti-inflammatory properties.
• The AKBA (3-O-acetyl-11-keto-beta-boswelic acid) substance seems to have the most anti-inflammatory effect (by inhibiting 5-lipoxygenase), however the amount (mg or %) of AKBA required for effectiveness is not known.

Does it Work? What the Science Says:

5-Loxin^® Boswellia Extract 50mg or 125mg (extract enriched to 30% AKBA)

• A randomized, double-blind, placebo-controlled study of 75 patients with mild to moderate OA that responded to NSAIDs or acetaminophen was performed over 90 days. Both doses (50mg bid and 125mg bid) showed clinical improvement on a 100 point VAS pain scale (change (%) improvement from baseline): -36 (63%) and -41 (74%)) versus placebo -15 (27%) and physical function using a 100 point WOMAC (-17 (41%) and -21 (55%) versus placebo -7 (18%)). More patients in the placebo group used rescue NSAIDs, likely contributing to the clinically important improvement in pain and function.  There were no clinically important differences in adverse effects compared to placebo.
• Small well-conducted trial concluded boswellia was effective for OA pain and functionality with a good safety profile.

ApresFLEX^® (formerly known as Aflapin) Boswellia Extract 50mg (extract enriched to 20% AKBA) and 5-Loxin^® Boswellia Extract 50mg (extract enriched to 30% AKBA)

• A randomized, double-blind, placebo-controlled study of otherwise healthy patients with mild to moderate OA was performed over 90 days and compared Aflapin 50mg bid vs 5-Loxin 50mg bid vs placebo. Clinically important reduction in outcomes from baseline were seen for VAS (58 vs. 46 vs. 20%) and WOMAC physical function (61 vs. 42 vs. 24%).  Additionally, more patients in the placebo group used ibuprofen as a rescue medication.
• Small well-conducted trial concluded boswellia extracts provided improvement in OA pain and functionality.

ApresFLEX^® Boswellia Extract 50mg (extract enriched to 20% AKBA)

• Another randomized, double-blind, placebo-controlled study of patients with severe OA examined the effect of ApresFLEX® for 30 days. Clinically important reduction in outcomes from baseline were seen for VAS (49 vs 17%) and WOMAC function (45 vs 9%). No clinically important adverse events were reported.
• Small well-conducted trial showing short term benefits in OA pain and functionality

Boswellia serrata extract (BSE) 169.33mg (extract enriched to 30% AKBA)

• Another study examined BSE 169.33mg bid vs. placebo in 48 newly diagnosed OA patients over 4 months showed clinically important improvement from baseline in 6-minute walk test (­80m v 10m), WOMAC total -27 vs -14, and pain VAS -2.7 vs -0.6. There were no significant adverse effects.
• Small well-conducted trial concluded boswellia extracts provided improve in OA pain and functionality

What are possible side effects and what can I do about them?

• Boswellia is generally well tolerated when used orally. Some reported side effects include diarrhea, nausea, abdominal pain, and heartburn.

Interactions

With drugs:

• Boswellia (in high doses) may have immunostimulant properties and thus MAY reduce the benefit of medications used to treat rheumatoid arthritis and other autoimmune conditions.
• Boswellia may moderately inhibit the liver enzymes that metabolize many other medications (CYP 1A2, 2C19, 2C9, 2D6, 3A4). This might increase the side effects of those medications. Check with your pharmacist before using boswellia.

With Other Diseases:

• Boswellia may have immunostimulant properties (at high doses). This may affect the control of autoimmune diseases like rheumatoid arthritis, lupus, and others.  At doses used for osteoarthritis an anti-inflammatory effect is noted.