Benefits
Knee joint comfort, stiffness and physical function
In a 120-day trial in 48 adults with knee osteoarthritis, Boswellin (169.33 mg twice daily) improved WOMAC pain, stiffness and function scores more than placebo. A second trial in 105 adults saw similar gains with 150 mg or 300 mg twice daily over 90 days; the difference from placebo was significant at days 60 and 90. Both trials were small and run mainly by the maker's scientists.
Lower hs-CRP and other blood markers of inflammation
In the 120-day knee trial, serum hs-CRP fell significantly with Boswellin compared with placebo. In the 90-day two-dose trial, TNF-alpha, hs-CRP and IL-6 also decreased in the Boswellin groups. These are blood markers measured in people with knee osteoarthritis, and both studies were run by the maker.
Walking distance and daily mobility
After 120 days, people taking Boswellin walked about 297 meters in six minutes versus about 227 meters on placebo, from similar starting points near 217 meters. In the 90-day trial, six-minute walking distance rose about 21% in both Boswellin groups. The 120-day trial also reported wider knee joint space on X-rays, shown with example images rather than a standard scoring method, so that finding is uncertain.
Knee comfort across boswellia extract trials
An independent pooled review of randomized knee osteoarthritis trials found boswellia extracts relieved pain and improved function more than placebo, with no difference in side effects. The reviewers rated study quality as low overall, noted most trials had fewer than 100 people, and said the evidence was not yet strong enough for firm clinical recommendations.
Mechanism of action
Boswellic acids and inflammatory enzymes
Boswellic acids were long thought to work mainly by blocking 5-lipoxygenase, an enzyme that makes leukotrienes. A pharmacology review noted that AKBA reaches only very low blood levels after oral intake, which makes that idea uncertain, and pointed to β-boswellic acid acting on microsomal prostaglandin E synthase-1 and cathepsin G instead.
Cytokine and NF-κB signaling in lab studies
In immune cells grown in the lab, Boswellin Super lowered TNF-alpha, IL-6, nitric oxide and COX-2 output and reduced activated NF-κB. In rats with induced arthritis, oral doses reduced paw swelling and blood markers such as CRP and prostaglandin E2. These are lab and animal findings from the maker.
Cartilage-degrading enzymes in lab studies
In the same maker-run work, the extract inhibited collagenase, elastase and hyaluronidase, enzymes that break down joint tissue, and preserved collagen in the joints of arthritic rats. Whether this happens in human joints has not been shown.
Clinical trials
Randomized, double-blind, placebo-controlled trial of Boswellin tablets (169.33 mg, about 30% AKBA) twice daily for 120 days, run by the maker's scientists. (Majeed et al. 2019, Phytother Res)
48 adults aged 35 to 75 with mild to moderate knee osteoarthritis in India; 42 completed.
Compared with placebo, Boswellin improved WOMAC scores, pain, the six-minute walk distance (about 297 vs 227 meters) and quality of life, and lowered serum hs-CRP. The authors reported wider joint space and fewer bone spurs on example X-rays without a standard scoring method. No serious adverse events were reported.
Randomized, double-blind, placebo-controlled, three-arm multicenter trial of Boswellin Super 150 mg or 300 mg twice daily for 90 days, with the product supplied by the maker and most authors employed by it. (Majeed et al. 2024, Front Pharmacol)
105 newly diagnosed adults aged 40 to 75 with knee osteoarthritis (Kellgren-Lawrence grade I to II) in India; 98 completed.
By day 90, VAS pain fell 45% and 62% and WOMAC total improved 69% and 74% in the 150 mg and 300 mg groups. The difference in pain from placebo was significant at days 60 and 90, not at day 5. TNF-alpha, hs-CRP and IL-6 decreased with Boswellin. No significant adverse events were recorded.
Systematic review and meta-analysis of randomized trials comparing curcuminoid or boswellia products with placebo or NSAIDs in knee osteoarthritis. (Bannuru et al. 2018, Semin Arthritis Rheum)
11 randomized trials with 1,009 participants, most with fewer than 100 people.
Boswellia products relieved pain and improved function more than placebo, with no difference in safety outcomes. Study quality was low overall, no trial compared boswellia with an approved NSAID, and the authors said the evidence was not adequate for clinical practice recommendations.