Alpha-keto-boswellic acid is one of the active constituents found in Boswellia serrata (Indian frankincense), a plant traditionally used in Ayurvedic medicine for inflammatory conditions, including rheumatoid arthritis (RA). While the broader resin extract (containing a mix of boswellic acids) has a long history of traditional use, the focus on alpha-keto-boswellic acid itself is more recent and is driven by scientific inquiry into the specific mechanisms of action.

Preclinical studies suggest that alpha-keto-boswellic acid and related boswellic acids inhibit 5-lipoxygenase, an enzyme involved in leukotriene synthesis, thereby reducing inflammation. Some in vitro and animal research also indicates that these compounds may reduce pro-inflammatory cytokine levels and protect joint tissue from inflammatory damage. However, while several clinical trials have evaluated Boswellia extracts in RA and osteoarthritis, most have not specifically isolated alpha-keto-boswellic acid as the tested compound. Thus, direct clinical evidence for alpha-keto-boswellic acid in RA is limited, though extracts containing it have shown modest benefits in reducing joint swelling and pain in RA patients.

In summary, the use of alpha-keto-boswellic acid for RA has some scientific rationale and indirect clinical support, but robust, targeted clinical trials are lacking. The overall quality of evidence specifically for alpha-keto-boswellic acid in RA is currently low to moderate.