The benefit of Curcuma longa and Boswellia serrata to improve quality of life in osteoarthritis patients: a randomized controlled trial


  • Rizaldy Taslim Pinzon Department of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia Department of Neurology, Bethesda Hospital, Yogyakarta, Indonesia
  • Rosa De Lima Renita Sanyasi Department of Neurology, Panti Rapih Hospital, Yogyakarta, Indonesia
  • Esdras Ardi Pramudita Department of Neurology, Panti Rapih Hospital, Yogyakarta, Indonesia
  • Septian Dewi Periska Department of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia



Curcuma longa, Boswellia serrata, Osteoarthritis, 5Q-5D-5L, Quality of life


Background: Quality of life (QoL) can be affected by chronic pain in osteoarthritis (OA). Previous studies showed that combination of Curcuma longa (CL) and Boswellia serrata (BS) extract (CB extract) are promising for alternative treatment for pain in OA. This study aimed to measure the benefit of CB extract to improve QoL in patients with OA.

Methods: This was a randomized controlled trial (RCT) in OA patients. Subjects were randomized to 3 different group (Group 1: CB extract (350 mg of CL and 150 mg BS) and NSAID (400 mg ibuprofen or 50 mg diclofenac sodium); group 2: CB extract; group 3: NSAID). Each medication was taken two times per day for 4 weeks. QoL measured using 5Q-5D-5L that include five dimensiones in 5Q-5D: mobility, self-care, usual activities, pain/discomfort, anxiety/depression, with 5 levels of severity.

Results: There were 105 subjects at baseline. After 4 weeks of study, remained 95 subjects. The most common problem in group 1, 2, and 3 was pain (n=23, n=8, n=15 respectively). The improvement of level of severity in group 1 after 4 weeks of treatment was significant in mobility problems (p=0.002), pain/discomfort (p<0.001), and anxiety/depression (p=0.008). A significant improvement was only seen in usual activity problems (p=0.013) in group 2. The decrease of level of severity in usual activity problems (p=0.034), pain/discomfort (p=0.005), and anxiety/depression (p=0.018) in group 3 were also statistically significant.

Conclusions: CB extract was beneficial to improve QoL in OA patients with a less side effect compared to NSAID.


McCarberg BH, Nicholson BD, Todd KH, Palmer T, Penles L. The Impact of Pain on Quality of Life and the Unmet Needs of Pain Management: Results From Pain Sufferers and Physicians Participating in an Internet Survey. Am J Therap. 2008;15:312-20.

Axford J1, Butt A, Heron C, Hammond J, Morgan J, Alavi A, et al. Prevalence of anxiety and depression in osteoarthritis: use of the hospital anxiety and depression scale as a screening tool. Clin Rheumatol 2010;29:1277-83.

Hasche LK, Morrow-Howell N, Proctor EK. Quality of life outcomes for depressed and nondepressed older adults in community long-term care. Am J Geriatr Psychiatr. 2010;18(6):544-53.

Carcolé M, Zamanillo D, Merlos M, Fernández-Pastor B, Cabañero D, Maldonado R. Blockade of the Sigma-1 Receptor Relieves Cognitive and Emotional Impairments Associated to Chronic Osteoarthritis Pain. Front. Pharmacol. 2019;10:468.

Glyn-Jones S, Palmer AJ, Agricola R, Price AJ, Vincent TL, Weinans H, et al. Osteoarthritis. Lancet. 2015;386(9991):376-87.

Global Burden Disease 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015:a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-602.

Sofat N, Kuttapitiya A. Future directions for the management of pain in osteoarthritis. Int J Clin Rheumtol. 2014;9(2):197-276.

Davis JS, Lee HY, Kim J, Advani SM, Peng HL, Banfield E, et al. Use of non-steroidal anti-inflammatory drugs in US adults: changes over time and by demographic. Open Heart. 2017;4:e000550.

Sostres C, Gargallo CJ, Arroyo MT, Lanas A. Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs, aspirin and coxibs) on upper gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2010;24(2):121-32.

Ross SM. Turmeric (Curcuma longa) Effects of Curcuma longa Extracts Compared With Ibuprofen for Reduction of Pain and Functional Improvement in Patients With Knee Osteoarthritis. Holist Nurs Pract. 2016;30(3):183-86.

Kuptniratsaikul V, Dajpratham P, Taechaarpornkul W, Buntragulpoontawee M, Lukkanapichonchut P, Chootip C, et al. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clin Interv Aging. 2014;20;9:451-8.

Farr II J, Miller LE, Block JE. Quality of Life in Patients with Knee Osteoarthritis: A Commentary on Nonsurgical and Surgical Treatments Open Orthop J. 2013;7:619-23.

Kawano MM, Araújo ILA, Castro MC, Matos MA. Assessment of quality of life in patients with knee osteoarthritis. Acta Ortop Bras. 2015;23(6):307-10.

Bilbao A, Garxia-Perez L, Arenaza JC, Garcia I. Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability, validity and responsiveness. Quality of Life Res. 2018;27(5).

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163-96.

Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197-223.

Noroozian M, Raeesi S, Hashemi R, Khedmat L, Vahabi Z. Pain: The Neglect Issue in Old People’s Life. Open Access Maced J Med Sci. 2018;6(9):1773-8.

Kidd B. Mechanisms of Pain in Osteoarthritis. HSS J. 2012;8(1):26-8.

Neogi T. The Epidemiology and Impact of Pain in Osteoarthritis. Osteoarthritis Cartilage. 2013;21(9):1145-53.

Richards MM, Maxwell JS, Weng L, Angelos MG, Golzarian J. Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine. Phys Sportsmed. 2016;44(2):101-8.

Robinson WH, Lepus CM, Wang Q, Raghu H, Mao R, Lindstrom TM, et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016;12(10):580-92.

Kocaadam, B., Saniler, N. Curcumin, an active component of turmeric (Curcuma longa), and its effects on health. Crit Rev Food Sci Nutr. 2017;57(13):2889-95.

Nagpal, M., Sood, S. Role of curcumin in systemic and oral health: An overview. J Nat Sci Biol Med. 2013;4(1):3-7.

Ramadan, G., Al-Kahtani, M.A., El-Sayed, W.M. Anti-inflammatory and anti-oxidant properties of Curcuma longa (turmeric) versus Zingiber officinale (ginger) rhizomes in rat adjuvant-induced arthritis. Inflammation. 2011;34(4):291-301.

Chandrasekaran CV, Sundarajan K, Edwin JR, Gururaja GM, Mundkinajeddu D, Agarwal A.. Immune-stimulatory and anti-inflammatory activities of Curcuma longa extract and its polysaccharide fraction. Pharmacognosy Res. 2013;5(2):71-9.

Pinsornsak P, Niempoog S. The efficacy of Curcuma Longa L. extract as an adjuvant therapy in primary knee osteoarthritis: a randomized control trial. J Med Assoc Thai. 2012;95(Suppl 1):S51-8.

Siddiqui MZ, Boswellia S. A Potential Antiinflammatory Agent: An Overview. Indian J Pharm Sci. 2011;73(3):255-61.

Umar S, Umar K, Sarwar AH, Khan A, Ahmad N, Ahmad S, et al. Boswellia serrata extract attenuates inflammatory mediators and oxidative stress in collagen induced arthritis. Phytomedicine. 2014;21(6):847-56.

Panahi Y, Rahimnia AR, Sharafi M, Alishiri G, Saburi A, Sahebkar A. Curcuminoid treatment for knee osteoarthritis: a randomized double‐blind placebo‐controlled trial. Phytother Res. 2014;28:1625-31.

Roth SH, Anderson S. The NSAID dilemma: managing osteoarthritis in high-risk patients. Phys. Sportsmed. 2011;39(3):62-74.

Appelboom T, Maes N, Albert A. A New Curcuma Extract (Flexofytol®) in Osteoarthritis: Results from a Belgian Real-Life Experience. The Open Rheumatol J. 2014;8:77-81.

Haroyan A, Mukuchyan V, Mkrtchyan N, Minasyan N, Gasparyan S, Sargsyan A, et al. Efficacy and safety of curcumin and its combination with boswellic acid in osteoarthritis: a comparative, randomized, double-blind, placebo-controlled study. BMC Complement Altern Med. 2018;18(1):7.






Original Research Articles