Kempegowda Institute of Medical Sciences
FRANKINCENSE (BOSWELLIA SERRATA)
APPLICATION IN OSTEOARTHRITIS (ARTHRITIS)
Sami Labs Limited, Research & Development Division
Results of randomized studies on the effects of administering a preparation based on boswellia serrata extract standardized to 30% AKBA in patients with radiologically confirmed art
Extracts from the gum resin of Boswellia Serrata (family: Burseraceae), also known as Indian frankincense, have been used in traditional Ayurvedic medicine in India for centuries to treat chronic inflammatory diseases, including arthritis (Ammon, 2016; Ernst, 2008).
In recent years, the potent anti-inflammatory, anti-arthritic, and analgesic effects of Boswellia Serrata gum resin extract have garnered significant attention from researchers (Abdel-Tawab, Werz, & Schubert-Zsilavecz, 2011).
Boswellic acids containing β-carboxyl groups are considered to be the biologically/pharmacologically active compounds (Sailer et al., 1996).
Here they are:
β-boswellic acid

acetyl-β-boswellic acid

11-keto-β-boswellic acid

- acetyl-11-keto-β-boswellic acid (AKBA)

The primary action of boswellic acids is:
the inhibition of the arachidonic acid cascade,
which prevents the release of cellular hormones responsible for causing inflammation.

Over the years, numerous studies have been conducted on the efficacy of Boswellia Serrata extracts. Unfortunately, many of these studies did not meet the basic research criteria required today, such as being conducted on small groups of patients without control groups.
The following results are from a study aimed at thoroughly evaluating the efficacy and safety of administering Boswellia Serrata extract standardized to 30% AKBA. The study was conducted in full compliance with scientific requirements for clinical trials.
Methodology:
The participants in the study were 48 individuals diagnosed with knee osteoarthritis. The patients were divided into two equal-sized groups, with one group receiving tablets containing Boswellia Serrata extract and the other group receiving a placebo. The clinical trial lasted for 120 days in 2014.
The study was conducted at the Kempegowda Institute of Medical Sciences, Bangalore, India.
⏱ Results:
Grupa pacjentów otrzymująca placebo:
🔬6-MINUTE WALK TEST (in meters).
Group receiving Boswellia Serrata extract (BS):
Group receiving placebo:
🔵 Conclusions:
1. The results of this study provide clinical evidence supporting the hypothesis that biologically active components of Boswellia Serrata extract, specifically AKBA and BBA boswellic acids, act synergistically, exerting anti-inflammatory effects. These extracts also effectively reduce joint pain and improve daily functioning.
2. The absence of serious adverse events confirms the pharmacological safety of Boswellia Serrata extract use.
3. Boswellia Serrata extract should be considered a viable candidate for the treatment of knee osteoarthritis.
📚 References:
Abdel‐Tawab, M., Werz, O., & Schubert‐Zsilavecz, M. (2011). Boswellia serrata. Clinical Pharmacokinetics, 50(6), 349–369. https://doi.org/10.2165/11586800‐000000000‐00000; Ammon, H. (2016). Boswellic acids and their role in chronic inflammatory diseases. In Anti‐inflammatory nutraceuticals and chronic diseases (pp.291–327). Springer International Publishing AG, Switzerland.; Barbour, K. E., Helmick, C. G., Boring, M., & Brady, T. J. (2017). Vital signs: Prevalence of doctor‐diagnosed arthritis and arthritis‐attributable FIGURE 4 Mechanisms of action of β‐boswellic acids against osteoarthritis (OA) of the knee. Biologically active constituents of BSE, namely, β‐boswellic acid (BBA) and 3‐acetyl‐11‐keto‐β‐boswellic acid (AKBBA), act synergistically to exert anti‐inflammatory/anti‐arthritic activity to reduce joint pain and improve physical functional ability in patients with OA of the knee. ABBA: 3‐acetyl‐β‐boswellic acid; IL: interleukin; KBBA: 11‐ keto‐β‐boswellic acid; TNF‐α: tumor necrosis factor alpha [Colour figure can be viewed at wileyonlinelibrary.com]; 1466 MAJEED ET AL. activity limitation—United States, 2013–2015. MMWR. Morbidity and Mortality Weekly Report, 66(9), 246–253. https://doi.org/10.15585/mmwr.mm6609e1; Bonnet, C., & Walsh, D. (2005). Osteoarthritis, angiogenesis and inflammation. Rheumatology, 44(1), 7–16. https://doi.org/10.1093/rheumatology/keh344; Büchele, B., Zugmaier, W., & Simmet, T. (2003). Analysis of pentacyclic triterpenic acids from frankincense gum resins and related phytopharmaceuticals by high‐performance liquid chromatography. Identification of lupeolic acid, a novel pentacyclic triterpene. Journal of Chromatography B, 791(1–2), 21–30. https://doi.org/10.1016/S1570‐0232(03)00160‐0; Cheras, P. A., Myers, S. P., Paul‐Brent, P. A., Outerbridge, K. H., & Nielsen, G. V. (2010). Randomized double‐blind placebo‐controlled trial on the potential modes of action of sheaflex70TM in osteoarthritis. Phytotherapy Research, 24(8), 1126–1131. https://doi.org/10.1002/ptr.3075; Cuaz‐Pérolin, C., Billiet, L., Baugé, E., Copin, C., Scott‐Algara, D., Genze, F. Rouis, M. (2008). Antiinflammatory and antiatherogenic effects of the NF‐κB inhibitor acetyl‐11‐keto‐β‐boswellic acid in LPSchallenged ApoE−/− mice. Arteriosclerosis, Thrombosis, and Vascular Biology, 28(2), 272–277. https://doi.org/10.1161/ATVBAHA.107. 155606; Ernst, E. (2008). Frankincense: Systematic review. BMJ, 337, a2813. https://doi.org/10.1136/bmj.a2813; Glyn‐Jones, S., Palmer, A., Price, A., Vincent, T., Weinans, H., & Carr, A. J. (2015). Osteoarthritis. The Lancet, 386(9991), 376–387. https://doi.org/10.1016/S0140‐6736(14)60802‐3; Gupta, P., Samarakoon, S., Chandola, H., & Ravishankar, B. (2011). Clinical evaluation of Boswellia serrata (Shallaki) resin in the management of Sandhivata (osteoarthritis). Ayu, 32(4), 478–482. https://doi.org/10.4103/0974‐8520.96119; Hashempur, M. H., Sadrneshin, S., Mosavat, S. H., & Ashraf, A. (2018).Green tea (Camellia sinensis) for patients with knee osteoarthritis: Arandomized open‐label active‐controlled clinical trial. Clinical Nutrition, 37(1), 85–90. https://doi.org/10.1016/j.clnu.2016.12.004; Henkel, A., Kather, N., Mönch, B., Northoff, H., Jauch, J., & Werz, O. (2012). Boswellic acids from frankincense inhibit lipopolysaccharide functionality through direct molecular interference. Biochemical Pharmacology, 83(1), 115–121. https://doi.org/10.1016/j.bcp.2011.09.026; Kimmatkar, N., Thawani, V., Hingorani, L., & Khiyani, R. (2003). Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee—A randomized double blind placebo controlled trial. Phytomedicine, 10(1), 3–7. https://doi.org/10.1078/094471103321648593; Maroon, J. C., Bost, J. W., & Maroon, A. (2010). Natural anti‐inflammatory agents for pain relief. Surgical Neurology International, 1, 80.; Natarajan, S., & Majeed, M. (2012). To assess the efficacy & safety of NILIN™ SR tablets in the management of osteoarthritis of knee. International Journal of Pharmacy & Life Sciences, 3(2), 1413–1423; Panahi, Y., Rahimnia, A. R., Sharafi, M., Alishiri, G., Saburi, A., & Sahebkar, A. (2014). Curcuminoid treatment for knee osteoarthritis: A randomized double‐blind placebo‐controlled trial. Phytotherapy Research, 28(11),1625–1631. https://doi.org/10.1002/ptr.5174; Pandey, R. S., Singh, B. K., & Tripathi, Y. B. (2005). Extract of gum resins of Boswellia serrata L. inhibits lipopolysaccharide induced nitric oxide production in rat macrophages along with hypolipidemic property. Indian Journal of Experimental Biology, 43(6), 509–516.