Meta-analyses of randomized controlled trials (RCTs) from 2015 to 2024 have consistently found that Boswellia improved pain, function, and stiffness (as evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index, or WOMAC) in osteoarthritis (OA). The effect sizes in each meta-analysis are large, but the quality of the evidence is often low.[1][2][3][4][5][6]
When looking at recent evidence from higher quality trials, the findings are promising: A 2024 meta-analysis examined 9 RCTs, of which 8 were graded as being of good quality, and found improvements in pain, stiffness, and function compared to a placebo,[1] and the improvements in pain and function were clinically significant.[7] Similarly, in a 2014 Cochrane review, the researchers found clinically significant effects on pain but not on function (though this finding was of borderline statistical significance) in 5 RCTs.[5]
Additionally, one meta-analysis was noteworthy in that in addition to the usual comparator of a placebo or an inactive control, Boswellia also improved outcomes compared to valdecoxib, an NSAID medication that can reduce pain and inflammation. However there were only 2 RCTs in this meta-analysis, and the evidence quality was rated as low.[6]
Unfortunately, many of the studies of Boswellia examined other interventions such as curcumin (another anti-inflammatory) as well, which contributes to the low quality of evidence in these studies.[1]
All of these studies considered, there is a reasonable level of evidence to suggest that Boswellia might improve pain, stiffness, and function in OA.