Potential complementary and/or synergistic effects of curcumin and boswellic acids for management of osteoarthritis

Abstract

For several thousand years (~4000) Boswellia serrata and Curcuma longa have been used in Aryuvedic medicine for treatment of various illnesses, including asthma, peptic ulcers, and rheumatoid arthritis, all of which are mediated through pathways associated with inflammation and pain. Although the in vivo pharmacology of both these natural ingredients is difficult to study because of poor bioavailability, in vitro data suggest that both influence gene expression mediated through nuclear factor kappa B (NF-κB). Therefore, the activity of pathways associated with inflammation (including NF-κB and lipoxygenase- and cyclooxygenase-mediated reduction in leukotrienes/prostaglandins) and those involved in matrix degradation and apoptosis are reduced, resulting in a reduction in pain. Additive activity of boswellic acids and curcumin was observed in preclinical models and synergism was suggested in clinical trials for the management of osteoarthritis (OA) pain. Overall, studies of these natural ingredients, alone or in combination, revealed that these extracts relieved pain from OA and other inflammatory conditions. This may present an opportunity to improve patient care by offering alternatives for patients and physicians, and potentially reducing nonsteroidal anti-inflammatory or other pharmacologic agent use. Additional research is needed on the effects of curcumin on the microbiome and the influence of intestinal metabolism on the activity of curcuminoids to further enhance formulations to ensure sufficient anti-inflammatory and antinociceptive activity. This narrative review includes evidence from in vitro and preclinical studies, and clinical trials that have evaluated the mechanism of action, pharmacokinetics, efficacy, and safety of curcumin and boswellic acids individually and in combination for the management of OA pain.

Efficacy of a proprietary combination of Tamarindus indica seeds and Curcuma longa rhizome extracts in osteoarthritis: a clinical investigation

“…The observations from the present study establish and validate the anti-OA efficacy and early onset of pain relief, improvements in musculoskeletal functions, and joint mobility in the male and female participants. Another objective of this study was to evaluate the clinical efficacy of a widely investigated combination of C. longa rhizome and B. serrata gum resin extracts ( 9 ). A meta-analysis performed on a series of preclinical and clinical studies supports that the blends of these two anti-inflammatory botanical extracts provide potential benefits in mitigating joint pain and improving musculoskeletal functions in OA subjects ( 9 ).…”

“…Therefore, medicinal plants have been explored adequately to overcome such adverse events ( 7 ). Previous studies have shown that the synergistic activity of curcumin and boswellic acids reduced the dosage and intake frequency of acetaminophen and NSAIDs ( 8 , 9 ). Despite advanced treatment options, no substantial therapy can curb the disease progression or avert structural damage ( 10 ).…”

“…This study was conducted in northern India, while the earlier study was performed in the southern part of India ( 11 ). Also, this study was intended to evaluate the efficacy of NXT15906F6 in parallel with a clinically proven and a widely investigated anti-inflammatory botanical blend of curcuminoids and boswellic acids that reported to mitigate joint pain and improve musculoskeletal functions in OA subjects ( 9 ). This 30-day randomized, placebo-controlled trial evaluated the primary clinical symptoms of OA, such as joint pain, stiffness, and physical function in the volunteers, improvements in musculoskeletal functions, an inflammatory marker in serum, and a cartilage degradation marker in the urine samples of the participants.…”

Herbal remedies as a potential alternative therapy for arthritis

“…Boswellia is very effective in reducing pain, providing a synergistic effect. Combining Boswellia with other herbal anti-inflammatories may be even more beneficial [64,65]. It has been shown that the combination of curcumin with boswellic acid is effective in reducing pain-related symptoms in patients with OA [65].…”

“…Several studies suggest a mix of curcumin with boswellic acid [64,65]. Both substances influence gene expression and modify the NFκB pathway.…”