Oral administration of Hyaluronic Acid polymer alleviates the symptoms of osteoarthritis in the knees: double-blind, placebo-control trial for a period exceeding 12 months
Osteoarthritis (OA) is a disease characterised by a gradual loss of cartilage which extends over years and decades. [...] Although OA can affect any synovial joint, OA of knee joints is the most cumbersome in terms of prevalence and disability. [...] Hyaluronic Acid (HA) is a mucopolysaccharide comprised of repeats of D-glucuronic acid and N-acetylglucosamine. It is abundantly present in the synovial fluid. [...] Compared with steroids, HA placed into joints may work more slowly, but its effect may last considerably longer. [...]
Material and Methods
The study was conducted as a randomised double-blind placebo-controlled trial. The 60 subjects
enrolled in the study were assigned to either the HA or the placebo group, [...]. Subjects in the HA group were requested to ingest 4 hard capsules containing a total of 200 mg of HA once a day after breakfast, everyday for 12 months. In the placebo group, subjects were asked to take 4 hard capsules which contained only cornstarch. [...]
In this study, patients’ symptoms were evaluated by the Japanese Knee Osteoarthritis Measures (JKOM) score, [...]. The symptoms of the subjects were recorded immediately before and at 2, 4, 6, and 12 months after the initial capsule administration, [...].
In the present study, HA was administered orally. Therefore, it is crucial that the orally administered HA is actually absorbed and distributed to the knee joints while retaining its biological activities.. [...] A series of experiments using radiolabelled HA indicated that orally administered HA would be indeed absorbed and distributed to the skin, bone, and synovial joints and would be retained in those tissues for prolonged periods. [...] The result of this study in which HA was orally administered over a 12-month period revealed a possibility that HA may alleviate knee OA symptoms in relatively young subjects [...]
Toshiyuki Tashiro, Satoshi Seino, Toshihide Sato, RyosukeMatsuoka, YasunobuMasuda and Naoshi Fukui: Oral Aministration of Polymer Hyaluronic Acid Alleviates Symptoms of Knee Osteoarthritis: A Double-Blind, Placebo-Controlled Study over a 12-Month Period. The Scientific World Jornal.
Boswellia serrata is a large branching tree found in India, Northern Africa, and the Middle East. [...] It has been traditionally used in the Ayurvedic system of medicine as anti-arthritic, astringent, stimulant, expectorant, and antiseptic.
Boswellia contains oils, terpenoids, sugars, and volatile oils. Four pentacyclic triterpene acids are also present, with beta-boswellic acid being the major constituent.
Mechanism of action
Studies performed in India show ingestion of a defatted alcoholic extract of Boswellia decreased polymorphonuclear leukocyte infiltration and migration, decreased primary antibody synthesis, and almost totally inhibited the Classical Complement Pathway.[...] In vitro testing reveals boswellic acids, isolated from the gum resin of Boswellia, in a dose-dependent manner, block the synthesis of proinflammatory 5-lipoxygenase products, [...]which cause bronchoconstriction, chemotaxis, and increased vascular permeability. [...]
Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause a disruption of glycosaminoglycan synthesis, accelerating articular damage in arthritic conditions. [...] Boswellia significantly reduced the degradation of glycosaminoglycans compared to controls; whereas, ketoprofen caused a decrease in total tissue glycosaminoglycan content.
In a double-blind, placebo-controlled trial, Boswellia demonstrated beneficial effects on knee osteoarthritis. [...] Patients in the Boswellia group experienced a significant decrease in pain and swelling and increase in range of motility compared to the placebo group.
Side Effects and Toxicity
Toxicity studies of Boswellia showed no pathological changes in hematological, biochemical, or histological parameters at doses higher than 1,000 mg/kg. [...]
Boswellia serrata. Alternative Medicine Review Volume 13, Number 2 2008.