Efficacy and Safety of Guggulu Tablet in Obesity and Rheumatic Disease Activity: An Open-Label, Single-Arm Clinical Trial

Background: Obesity and arthritis are major global health burdens, often coexisting and compounding morbidity through mechanical stress and systemic inflammation. Ayurveda describes Medoroga (obesity) and Sandhivata (arthritis) as conditions responsive to Guggulu (Commiphora wightii), a resin with lipid-lowering and anti-inflammatory properties. This study evaluated Guggulu tablets in adults with obesity and rheumatic disease activity. Methods: An open-label, single-arm, pre–post clinical trial was conducted at a rheumatology and obesity clinic in Pune, India. Forty participants (mean age 46.8 ± 9.5 years; 65% female; mean BMI 30.0 ± 2.8 kg/m²) with rheumatoid arthritis or osteoarthritis received purified Guggulu tablets (500 mg, twice daily) for 24 weeks. Primary endpoints included changes in body weight, BMI, waist circumference, and disease activity scores (DAS28, WOMAC, pain VAS). Secondary outcomes assessed inflammatory markers, metabolic parameters, lipid profile, and quality of life (HAQ DI). Results: Thirty-six participants (90%) completed the study. Body weight decreased by −4.3 kg, BMI by −1.6 units, and waist circumference by −5.0 cm (all p<0.001). DAS28 declined by −1.2 points, with 61% achieving MCID. WOMAC pain and function improved by −17.9 and −14.8 points, respectively, while pain VAS decreased by −20.9 mm. CRP (−2.5 mg/L) and ESR (−9.1 mm/hr) reduced significantly. Metabolic improvements included reductions in fasting glucose (−6.0 mg/dL), HbA1c (−0.3%), HOMA-IR (−0.8), total cholesterol (−12.2 mg/dL), LDL (−9.5 mg/dL), and an increase in HDL (+3.1 mg/dL). HAQ DI improved by −0.4. No serious adverse events occurred. Conclusion: Guggulu tablets produced clinically meaningful improvements in weight, metabolic parameters, inflammation, and arthritis-related outcomes, with good tolerability. These findings support Guggulu as a promising integrative intervention for obesity-associated rheumatic disease, warranting confirmation in larger randomized controlled trials.