Effectiveness of Boswellia in Rheumatoid Arthritis: A Systematic Review

This systematic review aims to determine the effectiveness of Boswellia in Rheumatoid Arthritis. The study analyzes the causes and impacts of Rheumatoid Arthritis and the effectiveness of Boswellia in reducing inflammation and pain. The study uses MeSH search terms and sets inclusion and exclusion criteria. The results suggest that Boswellia is highly effective in managing the complexities of Rheumatoid Arthritis.

SYSTEMATIC REVIEW
REPORT

Table of Contents
INTRODUCTION...........................................................................................................................1
Aim..............................................................................................................................................1
Objectives....................................................................................................................................1
Background of the study.............................................................................................................1
Rationale of the study.................................................................................................................1
METHOD........................................................................................................................................2
Search strategy............................................................................................................................2
Keywords used............................................................................................................................2
Me SH Search term.....................................................................................................................3
Inclusion and exclusion criteria..................................................................................................3
PRISMA Flow chart....................................................................................................................4
RESULTS AND DISCUSSION......................................................................................................5
Understanding the causes and impact of rheumatoid arthritis...................................................5
Determining the effectiveness of Boswellia in rheumatoid arthritis...........................................7
Discussion...................................................................................................................................8
RECOMMENDATIONS.................................................................................................................9
REFERENCES..............................................................................................................................11

INTRODUCTION
Aim
To understand effectiveness of Boswellia in rheumatoid arthritis.
Objectives
 To analyse the causes and impacts of rheumatoid arthritis.
 To determine the effectiveness of Boswellia in rheumatoid arthritis.
Background of the study
Boswellia is a genus of trees in the order Sapindales which is highly known for its
fragrant resin. It is extremely effective and can help to reduce the inflammation as well as allows
to lessen the Rheumatoid Arthritis. This acts as a painkiller and also help in order to prevent
from the loss of cartilage. Arthritis is basically a condition in which there is swelling along with
tenderness of one or more than one joints among old age people who are above 50 years (Wang
and et.al, 2018. Boswellia is a well-known herb among Indian frankincense as well which is also
known as resin herbal extract from the tree of Boswellia. These resins are utilized as a natural
medicine in order to treat Rhenumatoid arthritis which are associated from past various
centuries. It is extremely effectual over the inflammation and assist in order to get removal of
pain among the body which has been generally faced by the patient who have rheumatoid
arthritis. The primal reason behind this is due to inflammation in joints which can cause pain and
gets worse as the times passes. The Boswellia is effectual enough as it is anti-inflammatory
characteristics and have the suitability to provide high effectiveness in delivery of better
response towards the pain and inflammation.
Rationale of the study
The primary reason for doing this research is to evaluate the effectiveness of Boswellia
in Rhenumatoid arthritis disease. This in turn recognized as a research issue because
Rhenumatoid arthritis is a chronic, systemic autoimmune and inflammatory disease affecting the
joints with different levels of severity among patients. This disease not only affects the joints but
also internal organs as well and thus causing permanent disability in some instances (Riaz and
et.al, 2018). Currently, there is no cure for this specific disease, thus, the study over
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appropriateness of Boswellia is highly significant. It is an issue now because people are more
easily get into situations which can have high range of chances to get Rhenumatoid Arthritis.
Thus, with the help of systematic review over the topic, the study has shed their light on the
level to which the Boswellia is effective enough to reduce the pain related to Rhenumatoid
Arthritis.
METHOD
Search strategy
In order to conduct the present project or study, a systematic research strategy has been
identified. This helps to comprise in order to identify the key search terms and searching
effective databases in order to go searching for suitable articles as per the topic. While searching
the articles, the Boolean operators has been used for narrowing and broadening the research
study (Deveza and Bennell, 2021). Furthermore, the study also consists of setting inclusion as
well as exclusion criteria. Apart from this the study also utilizes the MeSH search terms to find
appropriate articles relevant to the topic.
Keywords used
Keywords are basically the searching terms or words that has been entered into the
database search boxes. They are the ones who represent the major concepts of the research topic
and are the words used in day to day life in order to illustrate the chosen topic. Without the
keywords, the scholar might have to face certain difficulties in order to find the appropriate and
relevant articles (Dodda and et.al, 2021. In order to conduct the present study there are certain
keywords or key search terms that has been used while searching over the topic:
Terms Synonyms
Boswellia -
Arthritis -
Impact Influence, effects
Effectiveness Potency, advantage
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Outcome Consequences, after effects
Issues Matter, concern
Treatment Medication, therapy
Inflammatory Provocative, fomenting, inflaming
Severity Extremity, seriousness
Me SH Search term
The medical subject heading's thesaurus is a controlled and hierarchically structured
vocabulary produced with the help of National Library of Medicine. This has been used in order
to go for indexing, cataloguing, and searching of biomedical as well as health related
informations. This search term includes the headings of the subject that has been appeared into
the MEDLINE, Pub Med, the NLM databases and other NLM catalogue (Qamar, Garg and
Srivastava, 2022. This research is based upon the subheadings such as “Therapy” is a word
which is used with a MeSH term that highlights a disease, when the article is based upon
treatment of that specific disease. Records within the Pub Med have been assigned subject
headings, a controlled vocabulary called Medical Subject Headings or Me SH in short terms.
These have been utilized in order to index citations allows the scholar to retrieve all records over
a specific subject regardless of the terminology utilized by the author.
Inclusion and exclusion criteria
Inclusion and exclusion criteria is defined as a context which can be included or
excluded from the study at the time of conducting research. The inclusion criteria decides and
identify the study population or number of articles reviewed in a reliable, consistent, objective
and uniform manner. The exclusion criteria are the factors or characteristics that make the
recruited population ineligible for the current study. These factors might be the con founders for
the final results parameters (Liu and et.al, 2020. Inclusion criteria are basically those
characteristics that are expected to be present in the research articles to be eligible to become
included in the review. In contrast to this, exclusive criteria are those which characterizes on the
basis of which research articles are excluded from the systematic review. The following
inclusion and exclusion criteria have been used in the present study such as:
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Inclusion Criteria Exclusion Criteria
Studies published in English language has
been included.
Studies publishes in any language other than
English have been excluded
Studies published after year 2018 Studies published before 2018
Studies over the effectiveness of Boswellia on
the Rhenumatoid arthritis disease.
Studies on the effectiveness of Boswellia on
any other disease have been excluded
Older people are considered within the study Cohort study and experimental study is also
excluded from the research procedure.
The disease which is rated with the joint pains
are associated with the study.
Children and adults are generally not
undertaken within the research topic
Boswellia is considered as natural resin for
management.
Allopathic drug and medications are excluded
from the context of study of articles chosen for
the study.
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PRISMA Flow chart
RESULTS AND DISCUSSION
Understanding the causes and impact of rheumatoid arthritis
In the study conducted by van der Woude and van der, (2018) it has been reviewed that,
rheumatoid arthritis leads to cause the pain, deformity and swelling to the people. This study
further stated that there are large number of people are facing the issue in regard to rheumatoid
arthritis. RA has been determined as an autoimmune-diseases which is characterized by the joint
inflammation. The major causes of the RA are entitled with the combination of the genetics,
environmental factors and hormones. In the article given by Skoczyńska and Świerkot, (2018) it
has been found that, major pathophysiology that is aligned with the RA denotes T-cell
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activation, dysregulated inflammation, autoantibody production, antigen presentation all are
serving as the mediators of the inflammatory process.
The study further witnessed that obesity plays the crucial role in increasing the extent of
RA in people. The factors that leads to cause the obesity has assured an adverse impact over the
arthritis. The cross sectional study has been done by Skoczyńska and Świerkot, (2018) and it has
been witnessed that people who consumes the sugary drinks that are rich in the fructose are
associated with the high risk is regards to developing arthritis. The plants whom seeds contains
the lectins often contributes in RA. In addition, it has been analysed that viruses such as, EBNA-
1, Fungi (Candida abicans) and plants (Glycine max, solanum lycopersicum) are the factors that
promotes the RA.
As per the views of Lwin and et.al., (2020) Over 60% if the people who are associated
with RA gets recovery after 12 months. However, most of the patient suffers from the severe
diseases due to the impact that has been created by RA. Rheumatoid Arthritis caused the
inflammation and damage to the joints. Furthermore, it can also develop the extra-articular
manifestation that leads to affect the major organs of the body. In the study of Skoczyńska and
Świerkot, (2018) it has been said that RA patients are more likely to prone with anxiety. Same
parameter has been witnessed in the study done by of Lwin and et.al., (2020). Medications that
has been used in RA leads to improve the depression and anxiety to the certain extent. RA leads
to create the situation of fatigue and high body pain in the people. Major depressive orders
(MDDS) has been witnessed in the RA patients. Often, quality of life (QoL) of the patient has
been significantly decreased due to the excessive fatigue, pain and disability that has been
created due to RA. In context of physical impact, it has been said by Skoczyńska and Świerkot,
(2018) that RA affects the joints in the hands, knees and the wrist. The damage has been created
to the tissue that leads to create higher pain in the patient. Furthermore, it creates the long-lasting
chronic pain, deformity and unsteadiness.
The study performed by van der Woude and van der, (2018), Skoczyńska and Świerkot,
(2018) and of Lwin and et.al., (2020) clearly stated the cause and impacts of rheumatoid
arthritis. However, the article that has been given by of Lwin and et.al., (2020) has clearly
provided the information in this context.
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Determining the effectiveness of Boswellia in rheumatoid arthritis
Choudhary and Shah, (2021) stated that, Boswellia refers to the herbal extract that has been
taken from Boswellia serrata tree. It is mainly used for treating the chronic inflammatory
changes. This leads to reduce the inflammation as it is an effective anti-inflammatory. This has
assured the effective result in the treatment of Rheumatoid arthritis. Boswellia has been proven
as effective pain-killer as well in the case of RA. Mahdian and et.al., (2020) Elucidates that, as
Boswellia has been proven effective in reducing the inflammation therefore, it had been proven
effective in reducing the symptoms of RA. It helps in preventing the loss of cartilage as well.
The traditional treatment of the RA can be supported with the help of boswellia. The benefits of
the boswellia is associated with reducing the pain in the joint of the patients and helps in healing
the tissue that causes the extreme pain in RA patients. However, on the other side the study done
by Choudhary and Shah, (2021) stated that there are certain side effects of boswellia but there is
no strong research has been performed in this context. thus, on the basis of this it can be sad that,
boswellia has been proven highly effective in managing the complexities that has been created
due to RA.
In the study done by Chaudhary and Fareed, (2022) the procedure in regards to working of
boswellia has been highlighted that sate that, bosellic acid leads to prevent the leukotrienes in
body. Leukotrienes has been defined as that molecule that mainly causes the inflammation in the
body. It has been often reviewed that taking certain extract of the boswellia reduce the pain up to
66 % and assures improvement in the mobility. Lindler and et.al., (2020) said that, Boswellia
leads to reduce the joint swelling in the patient that are facing RA. Also, it supports the immune
of the patient and helps in balancing the immune properties as well. Boswellia serrata reduces
the pain that leads to improve the knee-joint functions and provides the relief from pain.
Boswellia is mainly used for the management of the RA for reducing the joint pain and
improving the functions of the joint. The dosing guidelines of the Boswellia has been suggested
300-500 milligrams by the mouth in two or three times the day. Extracts of the boswellia serrata
sap taken by the mouth for the therapeutic purpose.
Thus, studies conducted by Choudhary and Shah, (2021), Mahdian and et.al., (2020),
Chaudhary and Fareed, (2022) and Lindler and et.al., (2020) stated the strong points that are
clearly depicting that bowellia has been proven highly effective in terms of managing the issues
of RA. In the study conducted by Choudhary and Shah, (2021) often it has been said that,
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boswellia contains side effects but the research has does not provided enough information that
can prove this. Therefore, it has been proven that boswellia has been proven highly effective in
managing RA.
Discussion
With the help of in depth analysis of the topic that is being used in order to do research over
the same, it has been identified that there are huge amounts of population who are facing
extreme difficulty in their day to day life due to getting infected from the Rhenumatoid arthritis
(Donovan and et.al, 2021). This specific issue have drastic impacts over the old age people such
as who are of 50years and more than that at which stage they require appropriate and better
response along with relief from pain as well as inflammation that occurs because of the
Rhenumatoid arthritis disease. Boswellia is considered as excellently effective remedy or herb
that lead towards creating high impacts over the delivery of better and appropriate responses
towards the health improvements for the older age people who are more than 50years of age
group (Sharma and Jana, 2020). From the detailed evaluation, it has been discussed that the
Boswellia has certain properties which includes anti-inflammatory as well as pain killer
properties which allows the patients to get better and suitable response towards delivering better
health benefits. Apart from this, the requirement about the usage of natural medication which are
getting used from the appropriate response for the RA patients.
On the basis of the above facts that has been shown as results it can be said that, RA lead to
cause the damage over the tissue that creates huge amount of pain in the patient and that often
leads to create the situation of anxiety, fatigue and depression issues. RA reduce the
effectiveness of the joint as well. Thus RA assures impact over the physical and the mental
aspects of the patient. Along with this, the factors that contributes in RA are associated with the
genetic and environmental factors. Also, it has been witnessed that obesity is one of the biggest
issue that contributes in RA. People who consume the diet that contains high sugar often faces
the complexities of RA (Sharma, Chaubey and Suvarna, 2021). It leads to create the situation of
depression and reduces the quality of life of patient as well. Thus, the impacts of the RA are
drastic as it impacts the physical and mental condition of the patient and also creates excessive
amount of pain. Thus, the impacts of RA create the numerous complexities for the patient that
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leads to create the critical situation for patient. Along with this, there is a threat in regards to
completely damaging of tissue in the joints.
It can be said that, Boswellia has been proven highly effective in terms of managing the
critical situation of RA. It decreases the extent of inflammation in the patient that leads to assure
relief from the pain. Therefore, it has been proven highly effective in the case of RA as it
manages the pain and inflammation. As a result, it manages the immune imbalances as well. The
tissue that has been damage due to RA has been healed with the consumption of Boswellia. The
acid that is mixed in boswellia leads to prevent the leukotrienes that causes the inflammation.
Within reducing the extent of molecules that cause inflammation, boswellia leads to reduce the
complexities of RA (Saleem and et.al., 2019). Thus, boswellia leads to managing the functions
of joint and often reduces the complexities of joints. Therefore, it has been proven effective in
the management of RA.
Hence, it has been proven that boswellia works within impacting the joint and managing the
immune activities that helps in RA diagnosis. Furthermore, it works as an effective pain relief
element that reduces the extent of pain due to the creation of damage in tissue. Within reducing
the molecules that cause inflammation it reduces the symptoms of the RA. Along with this it
often helps in managing physical and mental impacts that has been creates due to RA. However,
effective points in regards to side effect of boswellia has not been found. Thus, it clearly depicts
that boswellia is effectively managing the complexities of rheumatoid arthritis
RECOMMENDATIONS
From the above represented detailed evaluation, it has been recommended that Boswellia
is an effective herb or resin that can be utilized in order to reduce the impacts of inflammation
and pain which has been caused because of the Rhenumatoid Arthritis. According to the study
and various articles, it has been recommended that the specific herb is highly effective when it
will be taken three to four times per day with 300 to 400 milligrams through oral system
(Beringer and Miossec, 2019). Moreover, if the patient is undertaking any kind of medications,
then it should be suggested that they must use safety at the time of taking Boswellia as a
medicine and take a dose which is less than 1000 mg for up to maximum of 6 months. In
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addition to this, there are few more things that has been suggested to the patients who are
suffering from Rhenumatoid arthritis is to use and intake Boswellia which is highly effectual
along with allows the patients to get better response towards the delivery of getting better
optimistic impacts over the older people who are above the age of 50years. It is effective when
the results have been observed after minimum of four weeks of continuous dose with certain
limits while consuming the dosages. Moreover, there can also be some risks that are also being
involved and associated with the consumption of Boswellia along with taking care of the
Rhenumatoid arthritis patients in context of dosage volume as well in order to get better impacts
over the health status (Rudrappa, Chakravarthi and Benny, 2020).
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REFERENCES
Books and Journals
Beringer, A. and Miossec, P., 2019. Systemic effects of IL-17 in inflammatory arthritis. Nature
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assessment of a novel water-soluble extract of Boswellia serrata gum resin: acute
toxicity, 90-day sub-chronic toxicity, Ames’ bacterial reverse mutation, and in vivo
micronucleus assays. Toxicology Mechanisms and Methods, pp.1-11.
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Hangee-Bauer, C. and Younger, J.W., 2021. A Placebo-Controlled, Pseudo-
Randomized, Crossover Trial of Botanical Agents for Gulf War Illness: Curcumin
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