Effect of Nucart VG (Boswellia serrata in combination with veg glucosamine sulphate) in comparison with glucosamine sulphate to improve quality of life of knee osteoarthritis patients: a randomized controlled trial


  • Vijay G. Goni Department of Orthopaedics, PGIMR, Chandigarh, Punjab, India
  • Mukesh Mishra Department of Cardiology, Shatau Hospital, Nagpur, Maharashtra, India
  • Sailee Kadam Guffic Biosciences Ltd., Mumbai, Maharashtra, India
  • Sharat S. Gandhi Guffic Biosciences Ltd., Mumbai, Maharashtra, India




Boswellia serrata, glucosamine sulphate, EQ-5D, VAS, WOMAC


Background: Boswellia serrata has been proved to be an effective and safe herb for the treatment of osteoarthritis (OA). This study aims at assessing the synergistic effect of this herb with vegetarian glucosamine sulphate, a nutritional supplement, on knee osteoarthritis using quality of life indicators.

Methods: This was an open label, parallel group randomized trial of 12-week duration. Sixty-six subjects were equally randomized to two treatment arms: Boswellia serrata extract (600 mg) and glucosamine (750 mg) [Nucart VG]; and glucosamine sulphate (market comparator) 750 mg. Patients were administered 1 tablet twice-a-day post-meal for three months. Efficacy of treatment was measured on primary end-points like EuroQol-5D (EQ-5D) (health status indicator), visual analogue scale (VAS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scale (pain indicators), while safety was measured in terms of vital parameters. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed for comparing scores between the two groups.

Results: The baseline characteristics of patients between two groups were insignificantly different (p>0.05). In ITT analysis, the health status (EQ-5D score) of patients in Nucart VG group improved significantly than the comparator group at follow up 2 (p=0.037) and showed further improvement at follow up 3 (p=0.012). The pain indicators i.e. VAS and WOMAC scores were significantly lower in Nucart VG group right from follow up 1 till follow up 3 (p<0.05). Similar were the observations during PP analysis.

Conclusions: Nucart VG is beneficial for the treatment of mild to moderate knee OA, as inferred from the functional and health status assessment.

Author Biographies

Vijay G. Goni, Department of Orthopaedics, PGIMR, Chandigarh, Punjab, India

Medical Affairs

Mukesh Mishra, Department of Cardiology, Shatau Hospital, Nagpur, Maharashtra, India

Department of Cardiology,

Sailee Kadam, Guffic Biosciences Ltd., Mumbai, Maharashtra, India

Medical Director


Nuki G. Osteoarthritis: a problem of joint failure. Z Rheumatol 1999; 58: 142-7.

Silman AJ, Hochberg MC. Epidemiology of the Rheumatic Diseases. 2nd Ed. Oxford: Oxford University Press. 2001.

Symmons D, Mathers C, Pfleger B. Global Burden of Osteoarthritis in the year 2000: Report WHO Geneva. 2000.

Akinpelu AO, Alonge TO, Adekanla BA, Odole AC. Prevalence and pattern of symptomatic knee osteoarthritis in Nigeria: A community-based study. Internet J Allied Health Sci Pract. 2009;7:3.

Davis MA, Ettinger WH, Neuhaus JM and Hauck WW. Sex differences in osteoarthritis of the knee. The role of obesity. Am J Epidemiol. 1988; 127: 1019–30.

Solomon L, Beighton P, Lawrence JS. Rheumatic disorders in the South African Negro. Patrt II. Osteo-arthrosis. S Afr Med J. 1975;49:1737-40.

Gooch K, Culleton BF, Manns BJ. NSAID use and progression of chronic kidney disease. Am J Med. 2007;120: 280.

Sabzwari SR, Qidwai W, Bhanji S. Polypharmacy in elderly: a cautious trail to tread. J Pak Med Assoc. 2013;63:624-7.

Page J, Henry D. Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an under recognized public health problem. Arch Intern Med. 2000;160:777-84.

Clegg DO, Reda DJ, Harris CL. Glucosamine, chondroitin sulphate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006;354(8):795-808.

Wandel S, Juni P, Tendal B. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. Br Med J. 2010;341:4675.

Hua J, Suguro S, Iwabuchi K. Glucosamine, a naturally occurring amino monosaccharide, suppresses the ADP-mediated platelet activation in humans. Inflam Res. 2004;53(12):680-8.

Reginster JY, Deroisy R, Rovati LC. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001;357(9252):251-6.

Pavelka P, Gatterov´a J, Olejarova M. Glucosamine sulphate use and delay of progression of knee osteoarthritis: A 3-year, randomized, placebo- controlled, double-blind study. JAMA Int Med. 2002;162(18):2113-23.

McAlindon TE, La Valley MP, Gulin JP, and Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: A systematic quality assessment and meta-analysis. J Am Med Assoc. 2000;283(11):1469-75.

Dragos D, Gilca M. Phytomedicine in Joint Disorders. Nutrients. 2017;9(1):70.

Sailer ER, Subramanian LR, Rall B. Acetyl-11-keto--boswellic acid (AKBA): structure requirements for binding and 5-lipooxygenase inhibitory activity. Br J Pharmacol. 1996.

Reginster JY, Bruyere O, Neuprez A. Current role of glucosamine in the treatment of osteoarthritis. Rheumatology. 2007;46:731-5.

Runhaar J, Deroisy R, van Middelkoop M. The role of diet and exercise and of glucosamine sulfate in the prevention of knee osteoarthritis: Further results from the Prevention of knee Osteoarthritis in Overweight Females (PROOF) study. Semin Arthritis Rheum. 2016;45:42-8.

Al-Saadi HM. Multifaceted Protective Role of Glucosamine against Osteoarthritis: Review of Its Molecular Mechanisms. Sci Pharm. 2019;87:34.

Tiraloche G, Girard C, Chouinard L, Sampalis J, Moquin L, Ionescu M, et al. Effect of oral glucosamine on cartilage degradation in a rabbit model of osteoarthritis. Arthritis Rheum. 2005;52:1118-28.

Igarashi M, Sakamoto K, Nagaoka I. Effect of glucosamine on expression of type II collagen, matrix metalloproteinase and sirtuin genes in a human chondrocyte cell line. Int J Mol Med. 2017;39:472-8.

Sawitzke AD, Shi H, Finco MF. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-Year results from GAIT. Ann Rheum Dis. 2010;69(8):1459-64.

Zeng C, Wei J, Li H. Effectiveness and safety of glucosamine, chondroitin, the two in combination, or celecoxib in the treatment of osteoarthritis of knee. Sci Rep. 2015;5:16827.

Hochberg MC, Martel-Pelletier J, Monfort J. Combined chondroitin sulphate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2016;75(1):37-44.

Lomonte ABV, Mendonca JA, Brandao GC. Multicenter, randomized, double-blind clinical trial to evaluate efficacy and safety of combined glucosamine sulphate and chondroitin sulphate capsules for treating knee osteoarthritis. Adv Rheumatol. 2018;58:41.

Truong TTT, Lim JM, Cho HR. A double-blind, randomized controlled 12-week follow-up trial to evaluate the efficacy and safety of polycan in combination with glucosamine for the treatment of knee osteoarthritis. Evidence-Based Complementary and Alternative Medicine. 2019;9750531.






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