Fixed-Dose Herbal Extracts for Symptomatic Knee Osteoarthritis: Effectiveness and NSAID-Sparing Benefits
DOI:
https://doi.org/10.48047/f2n0a035Keywords:
Knee osteoarthritis, Apium graveolens, Boswellia serrata, NSAID-sparing effectAbstract
Background: Osteoarthritis (OA) of the knee is a leading cause of pain and disability among adults aged above 50 years in South India. Long-term reliance on non-steroidal anti-inflammatory drugs (NSAIDs) is constrained by gastrointestinal, cardiovascular, and renal toxicities, especially in elderly patients with comorbidities. Phytotherapeutic agents such as Apium graveolens (celery seed) and Boswellia serrata have demonstrated anti-inflammatory and analgesic activity through inhibition of the cyclooxygenase and 5-lipoxygenase pathways. Aim and Objective: To assess the clinical effectiveness and NSAID-sparing potential of a fixed-dose combination of celery seed extract and Boswellia serrata extract as adjuvant therapy in patients with symptomatic knee OA attending orthopaedic centres in Coimbatore and Madurai, Tamil Nadu. Materials and Methods: A multicentre, prospective, open-label observational study was conducted on 312 patients (aged ≥40 years) clinically diagnosed with primary knee OA according to American College of Rheumatology criteria. Participants received a celery seed (200 mg) and Boswellia serrata (250 mg) combination tablet twice daily for 90 days, in addition to ongoing therapy. Primary outcomes were Western Ontario and McMaster Universities Arthritis Index (WOMAC) total, pain, stiffness, and physical function scores, and the proportion of patients with reduced NSAID requirement. Secondary outcomes were Visual Analogue Scale (VAS) scores at rest and on movement. Results: Statistically significant improvements (p<0.001) were observed in the WOMAC total score (21.45%), WOMAC pain (71.83%), WOMAC stiffness (68.92%), and physical function (74.16%) subscales. The VAS at rest improved by 70.34% and on movement by 62.51%. Regular NSAID usage declined from 65.38% at baseline to 28.21% at day 90, with a parallel rise in paracetamol use from 16.99% to 34.62%. Conclusion: The celery seed and Boswellia serrata combination demonstrated clinically meaningful pain relief, improved joint function, and a substantial NSAID-sparing effect, supporting its role as a safer adjunctive therapy for the long-term management of knee osteoarthritis in the South Indian population.
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