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

Vidhu Sethi; Manohar Garg; Maxime Herve; Ali Mobasheri

doi:10.1177/1759720X221124545

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

Ther Adv Musculoskelet Dis. 2022 Sep 22:14:1759720X221124545. doi: 10.1177/1759720X221124545. eCollection 2022.

Authors

Vidhu Sethi¹, Manohar Garg², Maxime Herve³, Ali Mobasheri^{4

5}

Affiliations

¹ Pain Relief, Medical Affairs, Consumer Healthcare R&D, Haleon, 23, Rochester Park, GSK Asia House, 139234 Singapore.
² Nutraceuticals Research Program, University of Newcastle, Callaghan, NSW, Australia.
³ was an employee of Consumer Healthcare R&D, GlaxoSmithKline Consumer Healthcare, Singapore.
⁴ Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
⁵ World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Université de Liège, Liège, Belgium.

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.

Keywords: Boswellia serrata; complementary and alternative medicine; curcuma longa; nonsteroidal anti-inflammatory drugs (NSAIDs); osteoarthritis (OA); pain management; phytotherapy.

Publication types

Review