Boswellia serrata in osteoarthritis and rheumatoid arthritis: effects, mechanisms, and clinical evidence
DOI:
https://doi.org/10.12775/QS.2026.56.72067Keywords
Boswellia Serrata, Boswellic acids, osteoarthritis, rheumatoid arthritis, 5-lipoxygenase, phytotherapyAbstract
Background. Osteoarthritis (OA) and rheumatoid arthritis (RA) carry a large global burden, and standard pharmacotherapy is limited by gastrointestinal, renal and cardiovascular toxicity. Boswellia serrata oleogum resin has re-emerged as an anti-inflammatory adjunct.
Aim. To summarise current evidence on the phytochemistry, mechanisms, pharmacokinetics, clinical efficacy, and safety of Boswellia serrata in OA and RA.
Materials and methods. A structured search of PubMed, bioRxiv, Scopus and Google Scholar (1990–2026, with seminal pre-1990 records retained) combined Boswellia serrata, boswellic acid, AKBA, 5-LOX, NF-B, osteoarthritis, rheumatoid arthritis, pharmacokinetics and clinical trial.
Results. Boswellic acids, primarily AKBA, act through allosteric 5-LOX inhibition, IKK–NF-B suppression, anti-cytokine and anti-MMP effects, cathepsin G inhibition and Nrf2/HO-1 antioxidant activity. Standardised extracts produce clinically meaningful reductions in WOMAC and VAS scores in knee OA, and a Cochrane synthesis reports a 17-point VAS reduction at 90 days (NNT 2). RA evidence is sparser and provisional. Short-term safety is favourable; rare hepatic signals and CYP3A4-mediated interactions warrant attention.
Conclusions. Boswellia serrata is a multi-target adjunct with a reproducible mechanism, consistent symptomatic benefit in OA, an evidence-light role in RA and acceptable short-term safety; manufacturer-independent multi-centre RCTs are the priority.
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Copyright (c) 2026 Jakub Kazimierz Koszewski, Wiktoria Pielak, Anna Janiszewska, Wiktor Kołkowski, Jan Jakubczyk, Monika Wądołowska, Magdalena Antoszewska, Maria Grabowska, Katarzyna Gozdera, Katarzyna Oszast
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