Osteoarthritis can be classified as an inflammatory disease.¹ It is one of the most common musculoskeletal disorders², and is a leading cause of disability among older adults, affecting approximately one in eight.³ 

Individuals suffering from osteoarthritis experience substantial impact on their quality of life⁴, including impaired movement and chronic joint pain⁵ that is either constant or episodic.

The pathogenesis of osteoarthritis is characterised by destruction of articular cartilage, bone degradation and increased production of pro-inflammatory cytokines, such as interleukin 1β (IL-1β), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α). ²

These inflammatory cytokines may lead to increased production of cyclooxygenase-2 (COX-2), matrix metalloproteinase (MMP) synthesis and the destruction of collagen type 2, coupled with the reduced synthesis of collagenase inhibitors, collagen and proteoglycans.²

The elevation in levels of TNF-α and IL-1β results in multiple inflammatory cascades involving nitric oxide, free oxygen species and superoxide anions. The chronic inflammation driving loss of chondrocytes results in reduced thickness of cartilage in the affected joint.¹ This can result in the continuous degradation of cartilage, poor bone remodeling and increased risk of bony overgrowth.⁵

Independent research conducted on MediHerb’s Boswellia Complex found that the four herbs in this formulation – boswellia (Boswellia serrata), turmeric (Curcuma longa), ginger (Zingiber officinalis) and celery (Apium graveolens) complement each other by having somewhat different mechanisms of inflammatory action.

The National Institute of Complementary Medicine (NICM) at Western Sydney University tested the anti-inflammatory activity of the specific herbal extracts used in Boswellia Complex, as well as the four-herb formula.

In-vitro anti-inflammatory effects were established in cell-based assays, using lipopolysaccharide (LPS)-stimulated murine macrophages. The production of inflammatory mediators such as nitric oxide (NO), prostaglandin E2 (PGE2), leukotriene B4 (LTB4) and the cytokines TNF-α, IL-1β and IL-6 were measured as an established method of determining the anti-inflammatory activity of the herbal extracts.

The results highlighted:

• Turmeric showed strong dose dependent inhibition of NO, IL-1β, PGE2, and LTB4
• Ginger showed strong dose dependent inhibition of PGE2, NO, IL-6, IL-1β, LTB4 and TNF- α.
• Boswellia showed strong inhibition of IL-1β release and moderate dose dependent inhibition of NO.
• Celery showed strong inhibition of PGE2 and moderate inhibition of IL-1β, NO, TNF- α and IL-6.
• Boswellia Complex showed strong dose dependent inhibition of IL-1β and PGE2 release and moderate inhibition of LTB4 and NO.

These results highlight the broad range of anti-inflammatory activity of the herbs and suggest that when combined, they may exert potent anti-inflammatory actions through the downregulation of multiple inflammatory pathways. 

To further test this formulation for clinically relevant effects in patients with joint pain, Integria conducted a 4-week observational research study, utilising Mediherb Boswellia Complex prescribed in private clinical practice, predominantly naturopathic clinics. The pragmatic (real-life) study assessed the effectiveness of MediHerb’s Boswellia Complex on joint pain, stiffness and function. A total of 43 participants (32 females and 11 males) completed the study. The participants mostly suffered from osteoarthritis (43%), back pain (22%), non-specific joint pain (16%) and rheumatoid arthritis (8%). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) survey was administered before and after the 4-week supplementation of Boswellia Complex (average dosage was 3 tablets per day), there were no restrictions on co-prescriptions, lifestyle and dietary recommendations.

The WOMAC contains three separate areas of assessment, namely pain, stiffness and physical function. The results revealed that there was an average of a 22% reduction in pain, 28% reduction in stiffness and a 24% improvement in outcomes of physical function, such as climbing the stairs, domestic chores, shopping, rising from a chair, and getting out of bed. Of note, the overall pain scores showed a 34% reduction in present pain, 19% reduction in maximum pain and 28% reduction in average pain; all these outcomes were statistically significant. Mild adverse events were reported by three participants, however, none required cessation of Boswellia Complex.

Improving clinical outcomes 

Providing  effective and targeted treatment to improve our patients’ quality of life is of primary importance. Boswellia, turmeric, ginger and celery complement each other to form a potent anti-inflammatory formulation. The modulation of pro-inflammatory cytokines is a primary goal in treating osteoarthritis, as well as providing safe therapies that can reduce osteoarthritis symptoms.  

For Education purpose only not to be distributed

References

1. Chin K-Y. The spice for joint inflammation: anti-inflammatory role of curcumin in treating osteoarthritis. Drug Design, Development and Therapy 2016;10:3029-42.
2. Dorin Dragos MG, Laura Gaman, Adelina Vlad, Liviu Iosif, Irina Stoian, and Olivera Lupescu. Phytomedicine in Joint Disorders. nutrients 2017;9(70).
3. David J. Hunter DSaEC. The individual and socioeconomic impact of osteoarthritis. Nature Reviews Rheumatology 2014;10:437-41.
4. Aliasghar A. Kiadaliri CJL, Maria Gerhardsson de Verdier, Gunnar Engström, Aleksandra Turkiewicz, L. Stefan Lohmander and Martin Englund. Association of knee pain and different definitions of knee osteoarthritis with health-related quality of life: a populationbased cohort study in southern Sweden. BioMed Central 2016;14:121.
5. Bensky D, Clavey S, Stoger E. Chinese Herbal Medicine: Materia Medica. 3rd Edition ed. Seattle: Eastland Press; 2004.