Alternative treatment for osteoarthritis

Boswellia and its extracts may be an alternative treatment for osteoarthritis to help improve pain, stiffness, and joint function.

Osteoarthritis is the most common type of arthritis. Previously thought of as simple “wear-and-tear” type of arthritis, it is now recognized as a complex, progressive disease that affects the joints resulting in the breakdown of the joint cartilage and the underlying bone. Alternative treatments for osteoarthritis are being increasingly researched as strategies to manage this condition.

The hands and fingers, knees, hips, spine, and big toe are the most commonly affected joints. Symptoms of osteoarthritis include a limited range of motion, aching pain, weakness, stiffness, joint deformities, and morning stiffness lasting less than 30 minutes. Osteoarthritis pain progressively worsens in its later stages.

There are two types of osteoarthritis:

1. Primary, which usually occurs at ages greater than 65 years. Other risk factors include obesity, genetics, or joint abnormalities.
2. Secondary, which results from trauma or inflammatory damage from sports, occupation, and repetitive joint use.

Since there is no cure for osteoarthritis, the main treatment goals are pain control and quality-of-life improvements. Management and treatment options are based on the severity of symptoms.

Non-drug therapies include, but are not limited to:

• Structured exercise programs with a physiotherapist to help increase strength, flexibility, range of motion, and general mobility.
• Quality-of-life improvements with an occupational therapist to assess and recommend tools and aids for improved independence, such as use of a cane, raised seats, shoehorns, or buttonhooks.
• Massage of muscles by a registered massage therapist may help relieve and improve pain, stiffness, joint function, stress, and anxiety.
• Education on dietary changes and weight loss to alleviate joint stress.
• Joint replacement surgery is reserved for severe osteoarthritis and when other therapies fail.

Drug therapies include, but are not limited to:

• Acetaminophen to relieve pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs, e.g. Ibuprofen) to help relieve pain and inflammation.
• Topical treatments, such as anti-inflammatory (e.g. Diclofenac) or capsaicin creams.
• Duloxetine for no response or tolerance to acetaminophen or NSAIDs.
• Corticosteroid and hyaluronic acid injections are also available treatment options.

Boswellia for osteoarthritis

Research on Boswellia and its extracts have shown significant activity to combat inflammatory and arthritic diseases. Studies have shown that an active compound from Boswellia inhibits the inflammatory action caused by the enzyme, arachidonate 5-lipoxygenase. Clinical trials have reported that Boswellia and its extracts are relatively safe.

A review of seven studies investigated findings on the relief and improvement of pain, stiffness, and joint function using Boswellia as an alternative treatment for osteoarthritis. All seven studies utilized specific osteoarthritis pain rating scales and questionnaires to determine relief and improvement, such as the Visual Analog Score (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

The seven studies accounted for a total of 545 adults between 40 to 80 years old. All participants received either one of the following treatments for a duration of four or 12 weeks:

• 100mg to 250mg of Boswellia or its extract, versus placebo (i.e. sugar pill or rice bran).
• 100mg to 250mg of Boswellia or its extract, versus traditional medicine (i.e. ibuprofen or glucosamine).

The review reported that Boswellia and its extracts may improve pain, stiffness, and joint function compared to placebo or western medicine, making it a promising alternative treatment for osteoarthritis. Unfortunately, the review discovered that all seven studies had either unclear (86%) or high (57%) risk of bias. The risk of bias means that the study variations make it difficult for researchers to make consistent and solid conclusions. The unclear and high risk of bias stemmed from poor reporting of study procedures, such as randomization, allocation concealment, participant/researcher blinding, selective reporting and incorrect calculation of statistics.

Although Boswellia and its extracts seem safe, the safety data remains unclear with no reported side effects in Boswellia nor placebo treatment, from three out of seven studies. According to the authors, “The absence of information on adverse events does not mean that the intervention [Boswellia] is safe.”

This was the first study to provide a recommended dosage and duration of Boswellia and its extract, with 100 to 250 mg daily for four weeks. Boswellia’s safety and effectiveness as an alternative treatment for osteoarthritis requires further studies with larger population sizes, standardized dosing preparations, dosage outside of 100-250mg, and longer treatment durations.

Written by Manuel Bangsil, PharmD, MBA, BCMAS

References:

1. Hochman, J. et al. Osteoarthritis. Arthritis Society. https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/osteoarthritis. Updated September 2017. Accessed August 8, 2020.
2. Yu, G., Xiang, W., Zhang, T. et al. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complement Med Ther 20, 225 (2020). https://doi.org/10.1186/s12906-020-02985-6

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