Ayurveda extract helps reduce knee pain in elderly: Sabinsa Japanese RCT

Boswellin ​Super, a standardised extract from the gum resin of Boswellia serrata ​containing Boswellic acids, was evaluated for its role in musculoskeletal health in a randomised, double-blind, placebo-controlled clinical trial among Japanese adults.

Boswellia serrata is a tall tree of the family Burseraceae, native to India and parts of Pakistan, and its extracts are widely used in Ayurveda medicine.

Writing in the European Journal of Biomedical and Pharmaceutical Sciences​, researchers from Sabinsa, Sami Labs and ClinWorld said they wanted to assess if boswellic acids may be useful to reduce inflammation and prevent the damage to connective tissue.

“In recent years, the population of aging and elderly in Japan has seen a steady increase. Among them, several suffer from knee pain, lumbar pain, and shoulder pain. The effective relief of knee pain may help and improve the quality of life of elderly people because it enables increased physical activity. In this trial, we investigated the extract of Boswellia serrata as a treatment to relieve knee pain,”​ they wrote.

In the trial, 48 patients who experienced knee pain were assigned to receive either Boswellin  Super or a placebo once a day for eight weeks.

The participants were recruited by advertisements from all over Japan but most of them were from the Osaka area. Subjects aged in their 60s were preferentially recruited, followed by subjects in their 50s, 40s, 30s, and then 20s, until the required number of cases was achieved

Visual Analog Scale (VAS), the Japanese Knee Osteoarthritis Measure (JKOM) and the Western Ontario & Mc Master Universities Osteoarthritis Index (WOMAC) were used to evaluate knee pain. In addition, serum hyaluronic acid and high sensitivity C-reactive protein were measured as secondary outcome measures.

Compared with the baseline, the Boswellin  Super group patients showed significant improvements in the VAS, JKOM, and WOMAC scores after eight weeks of intervention.

“Serum hyaluronic acid levels were lower in the BS group than those in the placebo group after 8 weeks of intervention,” ​they wrote.

Inhibit activity

They added that hyaluronic acid levels could have been lower because the B. serrata extract may inhibit hyaluronidase activity, which in turn suppresses the outflow of hyaluronic acid to serum.

Previous studies have shown that patients with chronic rheumatoid arthritis or juvenile rheumatoid arthritis who felt joint pain showed high levels of serum hyaluronic acid, they said.

“Higher amounts of hyaluronic acid in the serum were thought to reflect an outflow from cartilaginous tissue and were possibly associated with stiff joints in the morning.​Therefore, knee joint pain could be correlated with high serum hyaluronic acid levels.”​

They concluded: “The findings of this trial indicate that BS inhibits the secretion of hyaluronic acid into the blood. Compared to the placebo group, the subjective symptoms of knee pain tended to improve. Therefore, ​Boswellin ​Super ​may be useful to relieve knee pain in Japanese adults.”​

Source: European Journal of Biomedical and Pharmaceutical Sciences​​

2016, Volume 3, Issue 10, 293-298.​

“Effect of Boswellin Super on Knee Pain in Japanese Aduults”.

Authors: Muhammed Majeed et al​.

The Japanese version of this story is available here​.