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Cited by 110Curcumin's Biomedical ApplicationsPharmacological Effects of Medicinal PlantsOsteoarthritis Treatment and Mechanisms

Efficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and meta-analysis

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Bannuru, Raveendhara R., Osani, Mikala C., Al-Eid, Fatimah, Wang, Chenchen·2018·Seminars in Arthritis and Rheumatism
DOI 10.1016/j.semarthrit.2018.03.001PMC PMC6131088
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Abstract

Purpose The unfavorable safety profiles of commonly prescribed knee osteoarthritis (OA) treatments have led clinicians and patients to seek safer alternatives. Research has suggested that curcuminoid and boswellia formulations could moderate key inflammatory pathways that are associated with worsening symptoms and disease progression. We conducted a systematic review and meta-analysis to assess the efficacy and safety of these treatments vs. placebo or NSAIDs for knee OA. Methods We searched Medline, EMBASE, Google Scholar, Web of Science and the Cochrane database from inception to February 21, 2018. We also hand searched reference lists and reviewed conference proceedings. We included randomized clinical trials (RCTs) comparing curcuminoid or boswellia formulations with placebo or NSAIDs for knee OA. We calculated standardized mean differences (SMD) or risk ratios (RR) for all relevant outcomes. Meta-analyses were conducted using random effects models. Heterogeneity was assessed using the I 2 statistic. Results Eleven RCTs (N = 1009) were eligible for analysis. Study quality was low overall, and most included RCTs were conducted on fewer than 100 participants. Both curcuminoid and boswellia formulations were statistically significantly more effective than placebo for pain relief and functional improvement. There were no significant differences between curcuminoids or boswellia and placebo in safety outcomes. Curcuminoids showed no statistically significant differences in efficacy outcomes compared to NSAIDs; patients receiving curcuminoids were significantly less likely to experience gastrointestinal adverse events. No RCTs compared boswellia against approved NSAIDs. Conclusions The results of our study suggest that curcuminoid and boswellia formulations could be a valuable addition to the knee OA treatment regimens by relieving symptoms while reducing safety risks. The current body of evidence is not adequate in size or quality to make any meaningful clinical practice recommendations. Further research through large, high quality RCTs probably investigating the synergistic effect of these products with other OA treatments is warranted.

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  • The therapeutic effects of CURs for knee OA uncovered by multiple reviews remained uncertain because reviews broadly involved trials with different agents-combined or CURs-free interventions.

    “Thus far, the therapeutic effects of CURs for knee osteoarthritis (OA) uncovered by multiple reviews remained uncertain due to broadly involving trials with different agents-combined or CURs-free interventions [8, 24–26], and evidence to reveal the clinical significance of CURs alone for knee OA is insufficient.”

    From Efficacy and safety of curcuminoids alone in alleviating pain and dysfunction for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials (2022) · cites this paper as [8]

    The Introduction (page unavailable) says earlier meta-analyses had methodological flaws, and the Results describe this review’s inclusion of curcuminoid-only, boswellia-only, and combination trials. But the paper does not attribute uncertainty about curcuminoids specifically to earlier reviews’ inclusion of combined or curcuminoid-free interventions; it names outdated trial data, pooling methods, and irreproducible results as flaws instead. (LLM, conf=0.83)

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  • Evidence to reveal the clinical significance of CURs alone for knee OA is insufficient.

    “Thus far, the therapeutic effects of CURs for knee osteoarthritis (OA) uncovered by multiple reviews remained uncertain due to broadly involving trials with different agents-combined or CURs-free interventions [8, 24–26], and evidence to reveal the clinical significance of CURs alone for knee OA is insufficient.”

    From Efficacy and safety of curcuminoids alone in alleviating pain and dysfunction for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials (2022) · cites this paper as [8]

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Cited by

Sorted by citations

Authors
Bannuru, R. R., Osani, M. C., Al-Eid, F., & Wang, C.
Affiliations
Tufts Medical Center (US)
Corresponding author
Bannuru, Raveendhara R.
ORCID
Venue
Seminars in Arthritis and Rheumatism
Publisher
Elsevier BV
Published
2018-12
Volume
48
Issue
3
Pages
416-429
ISSN
0049-0172 (ISSN-L)
DOI
10.1016/j.semarthrit.2018.03.001
PMC
PMC6131088
OpenAlex
W2791400362
Cited by
110
References
2
Citations by year
2026: 7 · 2025: 10 · 2024: 13 · 2023: 7 · 2022: 25 · 2021: 24 · 2020: 18 · 2019: 4 · 2018: 2
FWCI
1.00
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Seminars in Arthritis and Rheumatism (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Center for Complementary and Integrative Health (K23AT009374, K24AT007323)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Curcumin's Biomedical Applications
  • Health Sciences › Medicine › Pharmacology › Pharmacological Effects of Medicinal Plants
  • Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
Keywords
knee osteoarthritis, curcumin, Boswellia, curcuminoids, nonsteroidal anti-inflammatory drugs, analgesia, functional improvement, gastrointestinal adverse effects, herbal supplements, anti-inflammatory agents, treatment safety
MeSH terms
Anti-Inflammatory Agents, Non-Steroidal, Curcumin, Humans, Plant Extracts, Treatment Outcome, Osteoarthritis, Knee, Boswellia

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