From the Guidelines
Boswellia serrata extract is not recommended for the treatment of microscopic colitis due to low quality of evidence and uncertain balance between benefits and risks. The American Gastroenterological Association (AGA) suggests against treatment with Boswellia serrata over no treatment for the induction of clinical remission in patients with symptomatic microscopic colitis, based on a conditional recommendation with low quality of evidence 1.
Key Points to Consider
- The AGA guideline on the medical management of microscopic colitis provides a conditional recommendation against the use of Boswellia serrata for the treatment of microscopic colitis, citing low quality of evidence and uncertain balance between benefits and risks 1.
- A single randomized controlled trial showed that 44% of patients treated with Boswellia serrata improved clinically, compared to 27% of patients in the placebo arm, but the difference was not statistically significant and adverse events were more frequent 1.
- The panel had concerns regarding the feasibility of access to a standardized formulation of Boswellia serrata, given the numerous products available 1.
- For patients with microscopic colitis, the AGA recommends treatment with budesonide over no treatment for the induction of clinical remission, based on a strong recommendation with moderate quality of evidence 1.
Implications for Clinical Practice
- Boswellia serrata extract may be used for other conditions, such as osteoarthritis, rheumatoid arthritis, asthma, and inflammatory bowel diseases, but its use for microscopic colitis is not supported by the current evidence.
- Patients with microscopic colitis should be treated with budesonide as the first-line therapy, and maintenance therapy should be considered for patients who have had a clinical relapse after cessation of induction therapy 1.
From the Research
Uses of Boswellia Serrata Extract
- Boswellia Serrata extract is used to relieve pain and stiffness in patients with osteoarthritis (OA) 2, 3
- It is also used to improve joint function and reduce inflammation in OA patients 2, 3
- The extract has been shown to be effective in reducing inflammatory mediators and oxidative stress in collagen-induced arthritis 4, 5
- Boswellia Serrata extract has been found to preserve extracellular matrix in collagen-induced arthritis and reduce cartilage damage 5, 6
- It has also been used to alleviate pain and protect cartilage in monoiodoacetate-induced osteoarthritis in rats 6
Key Benefits
- Relieves pain and stiffness in OA patients
- Improves joint function and reduces inflammation
- Reduces inflammatory mediators and oxidative stress
- Preserves extracellular matrix and reduces cartilage damage
- Alleviates pain and protects cartilage in osteoarthritis
Studies Supporting its Use
- A systematic review and meta-analysis of randomized controlled trials found that Boswellia and its extract may be an effective and safe treatment option for OA patients 2
- A randomized double-blind placebo-controlled trial found that Boswellia Serrata extract was effective in reducing knee pain and improving knee function in OA patients 3
- Animal studies have shown that Boswellia Serrata extract reduces inflammatory mediators and oxidative stress, and preserves extracellular matrix in collagen-induced arthritis 4, 5