Frankincense — a resin from biblical times instead of joint pills?

Aim of the study: Osteoarthritis (OA) is a joint disease characterized by pain, inflammation, and physical disability. Boswellia serrata (BS) has been widely studied for its effectiveness in OA. Our systematic review and meta-analysis aimed to evaluate the efficacy of BS extract in OA. A subgroup analysis compared the efficacy of a standardized BS extract (AflapinⓇ) with that of other BS extracts.

Results: Nine RCTs with 712 participants were included. All studies except one were of good quality. Compared with control therapy, BS supplementation significantly reduced VAS (MD: -10.71; p<0.00001), LFI (MD: -2.99; p<0.00001), WOMAC-pain (MD: -10.69; p<0.0001), WOMAC-stiffness (MD: -5.49; p<0.00001), and WOMAC-function (MD: -10.69; p<0.00001) scores. In subgroup analysis, AflapinⓇ supplementation showed greater reductions in VAS (MD: -16.09 vs -4.68), LFI (MD: -3.81 vs -2.01), WOMAC-pain (MD: -18.68 vs -7.07), WOMAC-stiffness (MD: -14.25 vs -3.78), and WOMAC-function (MD: -14.99 vs -8.41) scores than other BS therapies. BS supplementation is effective for managing OA symptoms. Subgroup analysis found that AflapinⓇ supplementation may be better at improving OA symptoms, but this needs to be confirmed by more comparative clinical studies.

Aim of the study: Osteoarthritis (OA) is the most common form of inflammatory joint disease. Unfortunately, there is currently no suitable treatment for OA. Boswellia serrata has been considered a potent anti-inflammatory, anti-arthritic, and pain-relieving agent that could be used as a medicine for OA.

Results: Seven trials involving 545 patients were included. Compared with the control group, Boswellia and its extract may relieve pain [VAS: (WMD -8.33; 95% CI -11.19, - 5.46; P<0.00001); WOMAC pain: (WMD -14.22; 95% CI -22.34, - 6.09; P = 0. 0006)] and stiffness [WOMAC stiffness: (WMD -10.04; 95% CI -15.86, - 4.22; P = 0. 0007)], and improve joint function [WOMAC function: (WMD -10.75; 95% CI -15.06, - 6.43; P<0. 00001); Lequesne index: (WMD -2.27; 95% CI -3.08, - 1.45; P<0. 00001)]. Based on current evidence, Boswellia and its extract may be an effective and safe treatment option for people with OA. The recommended treatment duration with Boswellia and its extract is at least 4 weeks.

Aim of the study: Background: Knee osteoarthritis (KOA) is a common degenerative joint disease that can greatly affect quality of life in middle-aged and older people. Nutritional supplements are increasingly used for KOA because of their low risk, but direct comparative evidence of their effectiveness and safety remains scarce.

Results: Bayesian rankings indicated that Boswellia had the highest probability of being the most effective for pain and stiffness, while krill oil and curcumin showed potential to improve function. Conclusions: Nutritional supplements, particularly Boswellia, appear effective and well tolerated for improving KOA symptoms and function. These results suggest that some supplements may be useful as part of non-pharmacological KOA management. However, further large-scale, well-designed randomized controlled trials (RCTs) are needed to confirm these findings, particularly trials using more standardized dosages and formulations and evaluating long-term efficacy.

Aim of the study: To investigate the efficacy and safety of dietary supplements for patients with osteoarthritis.

Results: Of 20 supplements investigated in 69 eligible studies, 7 (collagen hydrolysate, passion fruit peel extract, Curcuma longa extract, Boswellia serrata extract, curcumin, pycnogenol, and L-carnitine) showed large effects (effect size >0.80) that were clinically important for reducing pain in the short term. Another six (undenatured type II collagen, avocado soybean unsaponifiables, methylsulfonylmethane, diacerein, glucosamine, and chondroitin) showed statistically significant improvements in pain, but their clinical importance was unclear. Only green-lipped mussel extract and undenatured type II collagen had clinically important effects on pain in the medium term. No supplements were found to have clinically important effects on long-term pain reduction. Similar results were found for physical function. Chondroitin showed statistically significant, but not clinically important, structural improvement (effect size -0.30, -0.42 to -0.17).

Aim of the study: The unfavorable safety profiles of commonly prescribed treatments for knee osteoarthritis (OA) have led clinicians and patients to seek safer alternatives. Research suggests that curcuminoid and Boswellia formulations could affect key inflammatory pathways associated with worsening symptoms and disease progression. We conducted a systematic review and meta-analysis to assess the efficacy and safety of these treatments vs.

Results: Eleven RCTs (N = 1009) were eligible for analysis. Overall study quality was low, and most included RCTs involved fewer than 100 participants. Both curcuminoid and Boswellia formulations were statistically significantly more effective than placebo for pain relief and functional improvement. There were no significant differences in safety outcomes between curcuminoids or Boswellia and placebo. Curcuminoids showed no statistically significant differences in efficacy outcomes compared with NSAIDs; patients taking curcuminoids were significantly less likely to experience gastrointestinal adverse events. No RCTs compared Boswellia with approved NSAIDs. Our results suggest that curcuminoid and Boswellia formulations could be a valuable addition to knee OA treatment regimens, relieving symptoms while reducing safety risks. The current body of evidence is not sufficient in size or quality to support meaningful clinical practice recommendations.

Aim of the study: Aflapin®, also known as AprèsFlex®, was developed as an enhanced-bioavailability extract of Boswellia serrata gum resin, standardized to 20% 3-O-acetyl-11-keto-β-boswellic acid. This randomized, double-blind, placebo-controlled clinical trial confirms the efficacy of Aflapin in easing the symptoms of osteoarthritis (OA) of the knee.

Results: Sixty-seven subjects completed the study. Aflapin led to significant improvements in pain scores as early as five days after treatment began. At the end of the trial, VAS, LFI, WOMAC pain, WOMAC stiffness, WOMAC function, and total WOMAC scores decreased in the Aflapin group by 45%, 40.9%, 44.4%, 66.3%, 44.4%, and 48%, respectively. Aflapin supplementation also reduced circulating MMP-3, TNFα, hsCRP, and C2C. This study confirms that Aflapin is clinically effective, fast-acting, and safe for managing osteoarthritis. No significant adverse effects were observed.

Aim of the study: A double-blind, placebo-controlled human trial was conducted to evaluate the safety and efficacy of standardized oral supplementation with Boswellin®, a novel Boswellia serrata extract (BSE) containing 3-acetyl-11-keto-β-boswellic acid (AKBBA) and β-boswellic acid (BBA). A total of 48 patients with knee osteoarthritis (OA) were randomized and assigned to the BSE or placebo group for the intervention.

Results: BSE also significantly reduced serum levels of high-sensitivity C-reactive protein, a potential inflammatory marker associated with knee OA. No serious adverse events were reported. This is the first study of BSE to last 120 days, longer than any previous clinical trial in patients with knee OA. The findings provide evidence that the biologically active constituents of BSE, namely AKBBA and BBA, act synergistically to produce anti-inflammatory and anti-arthritic effects, improving physical and functional ability while reducing pain and stiffness.

Aim of the study: Boswellia serrata Roxb. ex Colebr. (Family: Burseraceae; Genus: Boswellia) gum resin (Salai guggul) has great therapeutic value in Ayurvedic and Unani medicine for relieving several chronic inflammatory conditions, including arthritis, asthma, skin and blood diseases, and fever. SN13108F (Aflapin®) is a proprietary, standardized Boswellia serrata gum resin extract.

Results: SN13108F reduced Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analogue Scale, and Lequesne's Functional Index scores (p < 0.001; vs. baseline and placebo), and improved six-minute walk and stair-climb test results. MRI assessments of the tibiofemoral joints after the trial showed that cartilage volume, thickness, and joint space width increased (p < 0.001; vs. placebo), while levels of high-sensitivity C-reactive protein, matrix metalloproteinase-3, Fibulin-3, type II collagen degradation peptide in serum, and cross-linked C-terminal telopeptide of type II collagen in urine significantly decreased (p < 0.001; vs. baseline and placebo) in subjects taking SN13108F. Hematology, complete serum biochemistry, urinalysis, and participants’ vital signs did not change between the groups. SN13108F supplementation is safe and reduces joint pain while improving musculoskeletal function and cartilage structure in KOA.

Aim of the study: Boswellia serrata, also known as Indian frankincense, is a medicinal plant that has been used since ancient times in the traditional Indian medical system, Ayurveda. Historically, Boswellia extract has been used to treat pain associated with osteoarthritis, rheumatoid arthritis, and tendonitis.

Results: OLNP-27 significantly (P < .05) reduced total WOMAC, pain, stiffness, and visual analogue scores and improved physical function compared with placebo. OLNP-27 also significantly reduced the inflammatory marker high-sensitivity CRP compared with the placebo group. A statistically significant reduction in pain and stiffness was observed as soon as 7 days after starting OLNP-27 supplementation, indicating a rapid onset of action. It was also found to be safe and well tolerated during this study. Based on the findings of this study, OLNP-27 can be considered an effective and safe natural option for managing symptoms associated with knee osteoarthritis.

Aim of the study: Osteoarthritis (OA) is a major cause of pain and reduced mobility in older adults, and few effective treatments are currently available. This randomized, double-blind, placebo-controlled trial evaluated the efficacy and safety of Boswellia serrata extract (BOSMAX®), a botanical anti-inflammatory agent, in participants with no or mild OA.

Results: However, no significant changes were observed in SF-36 scores. Both treatments were well tolerated, with only one mild, unrelated adverse event reported. Vital signs, physical examinations, and laboratory measures remained clinically unchanged. BOSMAX® significantly improved knee joint symptoms and inflammatory markers over 90 days in people with no or mild OA, supporting its potential as a safe treatment option.