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Arthritis and Boswellia

Boswellia is more than the herb from which frankincense is obtained. It is effective also in the treatment of arthritis. Find out how.
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What is Boswellia?

Boswellia refers to a family of trees that produces fragrant resins including the incense called frankincense. Only four members of the Boswellia genus produce frankincense and the most important members of this genus in traditional medicine are B. serrata, B. dalzielli and B. sacra.

The resinous exudate of boswellia has been shown to possess therapeutic benefits. The major medicinal property of boswellia is its anti-inflammatory properties.

Therefore, boswellia species are used in different cultures to treat asthma, arthritis, fever, rheumatism and gastrointestinal disorders.

Of the different species of Boswelli, B. serrata is the one mostly used in herbal extracts and research.

This species is also sometimes called Salai Guggal especially in Indian Ayuverdic traditional medicine. The major bioactive compounds in boswellia are the boswellic acids which are terpenoids. They are the main ingredients of the gum resin.

Therefore, boswellia supplements are standardized around these acids. Boswellia herbal supplements are manufactured to contain 37.5% – 65% of boswellic acids.  They are available as tinctures, capsules and tablets.

However, boswellia also contains essential oils including pinene, myrcene, limonene and cymene. These are the components of the steam-distilled boswellia oil since, unlike boswellic acids, they are volatile.

Besides their anti-inflammatory property, boswellic acids are also responsible for the anticancer, immunomodulatory (regulate the immune system) and hepatoprotective (protect the liver) properties of boswellia.

While boswellic acids protect the liver at low doses, they may actually cause liver damage at high doses. Therefore, the dose of boswellia supplement should not exceed the recommended values.

Boswellia can also provide pain relief, reduce total cholesterol levels, increase HDL (good cholesterol) levels, regulate sugar levels, treat diarrhea and serve as a broad-spectrum antibiotic.

Studies on the Efficacy of Boswellia in Arthritis Management

A 2003 study published in the journal, Phytomedicine, by Indian researchers examined the efficacy and tolerability of Boswellia serrata extracts in the treatment of osteoarthritis of the knee.

In this crossover study, 30 patients were divided into 2 groups.

In the first half of the study, one group received boswellia extracts while the other got placebo. After 8 weeks, a washout period was allowed before the placebo group was given boswellia extracts and the boswellia group changed to placebo.

All of the patients enrolled in this study saw their arthritic symptoms improve during the period on which they were placed on boswellia extracts. The improvement was deemed statistically and clinically better than the placebo effect.

These patients experienced lesser knee pain (analgesic effect), increased knee flexion (anti-arthritic effect) and decreased swelling (anti-inflammatory effect).

Only minor side effects were reported during the study and these were just gastrointestinal upsets.

In a 2008 study published by another group of Indian researchers, the effect of a standardized boswellia extract, 5-Loxin, was investigated for the treatment of osteoarthritis. This study used 3 drug choices for 75 study participants over the course of 90 days.

The study group was divided into three. One group took 100 mg of the boswellia extract; the second group took 250 mg of the extract; and the third group was given placebo.

Each patient was tested at the beginning and on days 7, 30, 60 and 90 of the trial.

The tests administered included evaluation of the levels of enzymes known to degrade the cartilage. Each patient was also rated for level of pain and degree of physical function.

The result of the study indicated that both doses of boswellia extracts performed better than placebo in relieving the symptoms of osteoarthritis. The levels of enzymes degrading the cartilage fell sharply in the groups receiving the drugs.

Furthermore, the group given 250 mg of boswellia extract saw improvements in symptoms as early as day 7 of the trials. This higher dose was concluded to be safe and effective while only causing side effects comparable to the ones seen with the lower dose.

Another study investigated the benefits of boswellia extract in the treatment of severe arthritis. It recruited 175 patients who suffered from arthritis for 1 – 6 years. 70% of the patients in this study group were bedridden with the disease.

Boswellia extract was able to improve morning joint pain, relieve general pain and reduce the difficulty of performing physical tasks in 67% of the study population. In 30% of the patients, the effects of boswellia were significant enough to be comparable to conventional arthritis medications.

How Boswellia Works for Arthritis

Boswellia produces its anti-inflammatory effect with far fewer side effects than conventional drugs such as the steroidal medication used to manage inflammation and the NSAIDs (non-steroidal anti-inflammatory drugs) used to manage pain and inflammation.

It is believed that the active agents in boswellia extracts inhibit inflammation by a mechanism different from the one used by NSAIDs such as aspirin and ibuprofen. While NSAIDs inhibit the activity of prostaglandins secreted by immune cells, boswellia extract inhibits the production of a specific leukotriene (LTB4).

LTB4 is secreted by neutrophils to attract more immune cells to the site of inflammation.

Boswellic acids are termed non-redox inhibitors of 5-lipoxygenase. 5-liopoxygenase is responsible for the production of LTB4 from arachidonic acid at the beginning of an inflammatory response. By inhibiting it, boswellia extract targets one of the biochemical cascade reactions leading to inflammation.

By interfering with the inflammatory process at an earlier stage, boswellia extract can produce better analgesic and anti-inflammatory effects than NSAIDs.

The boswellic acids in boswellia extracts have also been shown to improve the symptoms of local swelling due to edema. Since joint edema is often a feature of arthritis, boswellia is a safe alternative to conventional drugs for reducing water retention that may worsen arthritis.

These boswellic acids work by reducing the migration of leucocytes to these edematous joints, and therefore, reducing the volume of the water retained there.

Another way by which boswellic acids reduce inflammation is in the stabilization of the mast cells.

When mast cells are degranulated, they release inflammatory factors that cause inflammation especially during an anaphylactic reaction. Because boswellia extract can reduce this inflammation, it can be used to address the joint inflammation triggered by autoimmune reactions in osteoarthritis.

How to Use Boswellia for Arthritis

Although boswellia extracts are commonly taken orally in the treatment of arthritis, they are also available as ingredients of topical creams for the same indication.

However, some people do show allergic reaction to topical application of boswellia in the form of contact dermatitis. For such people, an oral boswellia supplement is recommended.

Since boswellia supplements contain different percentages of boswellic acids, it is difficult to establish a standard dose for the herbal supplement. Still, experts agree that 150 mg boswellic acids should be taken 3 times daily.

This dosage translates to 400 mg of boswellia extract (containing 37.5% of boswellic acids) taken 3 times daily.

The effect of boswellia extract in the treatment of arthritis is not instantaneous but cumulative. Therefore, the usual course of treatment should take at least 8 – 12 weeks before the first signs of improvement are to be expected.

Boswellia extract is safe to use even in long-term treatment.

Unlike NSAIDs, it does not irritate the lining of the gastrointestinal tract and will not increase the risk of developing stomach ulcers. It is even used to treat ulcerative colitis.

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