***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a double-blind , r and omized , multicentre clinical study , the efficacy and tolerance of a herbal medicine product , Harpadol ( 6 capsules/day , each containing 435 mg of powdered cryoground powder Harpagophytum procumbens ) , was compared with diacerhein 100 mg/day in the treatment , for 4 months , of 122 patients suffering from osteoarthritis of the knee and hip . Assessment s of pain and functional disability were made on a 10 cm horizontal visual analogue scale ; severity of osteoarthritis was evaluated by Lequesne 's index . Spontaneous pain showed a significant improvement during the course of the study and there was no difference in the efficacy of the two treatments . Similarly , there was a progressive and significant reduction in the Lequesne functional index and no statistical difference was found between Harpadol and diacerhein . At completion of the study , patients taking Harpadol  were using significantly less NSAIDs and antalgic drugs . The frequency of adverse events was significantly lower in the  Harpadol group . The most frequent event reported was diarrhea , occurring in 8.1 % and 26.7 % of Harpadol and diacerhein patients respectively . The global tolerance assessment by patients at the end of treatment favoured Harpadol . The results of this study demonstrate that Harpadol is comparable in efficacy and superior in safety to diacerhein OBJECTIVE To examine the rates of use and expenditures on alternative therapies by adults with osteoarthritis ( OA ) . METHODS Adults with OA recruited from the community to participate in a r and omized clinical trial recorded alternative and traditional health care use on postcard diaries . General and arthritis-specific quality of life was assessed by question naires . RESULTS More than 47 % of participants reported using at least one type of alternative care  during the 20-week intervention period . Among alternative care consumers , the most commonly used treatments were massage therapy ( 57 % ) , chiropractic services ( 20.7 % ) , and nonprescribed alternative medications ( 17.2 % ) . Four percent of subjects reported using only alternative care during the study period . Expenditures for alternative therapy averaged $ 1,127 per year , compared with $ 1,148 for traditional therapies . CONCLUSION Use of and expenditures for alternative care  were high among this cohort of older adults with OA . Clinicians may want to inquire about use of these therapies before recommending treatments for this condition Background This study was design ed to determine if a natural mineral supplement , sierrasil , alone and in combination with a cat 's claw extract ( Uncaria guianensis ) , vincaria , has therapeutic potential in mild to moderate osteoarthritis of the knee . Methods Patients ( n = 107 ) with mild to moderate osteoarthritis of the knee were r and omly assigned to one of 4 groups ; high dose sierrasil ( 3 g/day ) , low dose sierrasil ( 2 g/day ) , low dose sierrasil ( 2 g/day ) + cat 's claw extract ( 100 mg/day ) or placebo , administered for 8 weeks . Treatment was double blinded . Primary efficacy variables were WOMAC scores ( A , B , C and total ) . Visual analog score ( VAS ) for pain , consumption of rescue medication ( paracetamol ) , and tolerability were secondary variables . Safety measures included vital signs and laboratory-based assays . Results Ninety-one of the 107 patients successfully completed the protocol . All four groups showed improvement in WOMAC and VAS scores after 8 weeks ( p < 0.001 ) , in all 3 groups receiving sierrasil the magnitude of benefits were greater vs. placebo ( WOMAC Total 38–43 % vs. 27 % ) but this was not statistically significant . In reference to baseline values sierrasil treated groups had a considerably faster onset of benefits . Placebo-treated individuals failed to show significant benefits at 4 weeks ( 11 % reduction in total WOMAC ) . In contrast , after 1 or 2 weeks of therapy all the sierrasil groups displayed significant reductions in WOMAC scores ( p < 0.05 ) and at week 4 displayed a 38–43 % improvement . VAS was significantly improved at 4 weeks in all groups ( p < 0.001 ) but was significantly greater in all sierrasil groups compared to placebo ( p < 0.05 ) . Rescue medication use was 28 - 23 % lower in the herbomineral combination and high dose sierrasil groups although not statistically different from placebo ( P = 0.101 and P = 0.193 , respectively ) . Tolerability was good for all groups , no serious adverse events were noted and safety parameters remained unchanged . Conclusion The natural mineral supplement , sierrasil alone and in combination with a cat 's claw extract , improved joint health and function within 1–2 weeks of treatment but significant benefits over placebo were not sustained , possibly due to rescue medication masking . Sierrasil may offer an alternative therapy in subjects with joint pain and dysfunction Objective To evaluate the effect of niacinamide , on selected parameters of  osteoarthritis  using a doubleblind , placebo controlled study design . Methods Seventy two patients with osteoarthritis were r and omized for treatment with niacinamide or an identical placebo for 12 weeks . Outcome measures included global arthritis impact and pain , joint range of motion and flexibility , erythrocyte sedimentation rate , complete blood count , liver function tests , cholesterol , uric acid , and fasting blood sugar . Compliance was monitored with a pill record sheet and interview . Results Global arthritis impact improved by 29 % ( 95 % confidence interval [ CI ] 6 , 46 ) in subjects on niacinamide and worsened by 10 % in placebo subjects ( p=0.04 ) . Pain levels did not change but those on niacinamide reduced their anti-inflammatory medications by 13 % ( 95 % CI 9 , 94 ; p=0.01 ) . Niacinamide reduced erythrocyte sedimentation rate by 22 % ( 95 % CI 6 , 51 ; p<0.005 ) and increased joint mobility by 4.5 degrees over controls ( 8 degrees vs. 3.5 degrees ; p=0.04 ) . Side effects were mild but higher in the niacinamide group ( 40 % vs 27 % , p=0.003 ) . Conclusion This study indicates that niacinamide may have a role in the treatment of osteoarthritis . Niacinamide improved the global impact of osteoarthritis , improved joint flexibility , reduced inflammation , and allowed for reduction in st and ard anti-inflammatory medications when compared to placebo . More extensive evaluation of niacinamide in arthritis is warranted OBJECTIVE Osteoarthritis ( OA ) is the most common form of arthritis and the second most common cause of long-term disability among middle-aged and older adults in the United States .  Methylsulfonylmethane ( MSM ) is a popular dietary supplement used as a single agent and in combination with other nutrients , and purported to be beneficial for arthritis . However , there is paucity of evidence to support the use of MSM . METHODS A r and omized , double-blind , placebo-controlled trial was conducted . Fifty men and women , 40 - 76 years of age with knee OA pain were enrolled in an outpatient medical center . Intervention was MSM 3 g or placebo twice a day for 12 weeks ( 6g/day total ) . Outcomes included the Western Ontario and McMaster University Osteoarthritis Index visual analogue scale ( WOMAC ) , patient and physician global assessment s ( disease status , response to therapy ) , and SF-36 ( overall health-related quality of life ) . RESULTS Compared to placebo , MSM produced significant decreases in WOMAC pain and physical function impairment ( P<0.05 ) . No notable changes were found in WOMAC stiffness and aggregated total symptoms scores . MSM also produced improvement in performing activities of daily living when compared to placebo on the SF-36 evaluation ( P<0.05 ) . CONCLUSION MSM ( 3 g twice a day ) improved symptoms of pain and physical function during the short intervention without major adverse events . The benefits and safety of MSM in managing OA and long-term use can not be confirmed from this pilot trial , but its potential clinical application is examined . Underlying mechanisms of action and need for further investigation of MSM are discussed OBJECTIVE To determine the benefit of cetylated fatty acids ( CFA ) on knee range of motion and function in patients with osteoarthritis ( OA ) . METHODS Sixty-four patients with chronic knee OA were evaluated at baseline and at 30 and 68 days after consuming either placebo ( vegetable oil ; n = 31 ) or CFA ( Celadrin ; n = 33 ) . Evaluations included physician assessment , knee range of motion with goniometry , and the Lequesne Algofunctional Index ( LAI ) . RESULTS After 68 days , patients treated with CFA exhibited significant ( p < 0.001 ) increase in knee flexion ( 10.1 degrees ) compared to patients given placebo ( 1.1 degrees ) . Neither group reported improvement in knee extension . Patient responses to the LAI indicated a significant ( p < 0.001 ) shift towards functional improvement for the CFA group ( -5.4 points ) after 68 days compared to a modest improvement in the placebo group ( -2.1 points ) . CONCLUSION Compared to placebo , CFA provides an improvement in knee range of motion and overall function in patients with OA of the knee .  CFA may be an alternative to the use of nonsteroidal antiinflammatory drugs for the treatment of OA BACKGROUND A st and ardized rose-hip powder produced from the seeds and husks of fruit from a subtype of Rosa canina has been reported to inhibit leukocyte functions that cause cell injury in osteoarthritis . OBJECTIVE The aim of this study was to assess the impact of st and ardized rose-hip powder on mobility of the hip and knee joints , activities of daily living , quality of life , and pain in patients with osteoarthritis . METHODS Patients with a diagnosis of osteoarthritis of either the hip or knee , verified on radiography , participated in this r and omized , placebo-controlled , double-blind study . Half of the patients were given five 0.5-g capsules of st and ardized rose-hip powder twice daily for 4 months , and the other half received identical placebo capsules twice daily for the same period . Mobility of the hip or knee was measured in both groups after the initial screening and again after 4 months of therapy . RESULTS One hundred patients ( 65 women , 35 men ; mean [ SD ] age , 65.2 [ 11.1 ] years ) were divided into 2 treatment groups of 50 patients each . Hip joint mobility improved significantly in the treatment group compared with the placebo group ( P = 0.033 ) . Similarly , pain decreased significantly in the treatment group compared with the placebo group ( P = 0.035 ) . Two patients ( 4 % ) from each group withdrew during the early stages of the trial for reasons not related to treatment . CONCLUSIONS In this study population , st and ardized rose-hip powder reduced symptoms of osteoarthritis , as 64.6 % of patients reported at least some reduction of pain while receiving treatment . St and ardized rose-hip powder may improve hip flexion and reduce pain in patients with osteoarthritis OBJECTIVE Evaluation of the effect of a ginger extract ( Zintona EC ) on patients suffering from gonarthritis . MATERIAL AND METHODS Twenty-nine patients ( 6 men and 23 women ) with symptomatic gonarthritis ( ACR criteria ) , in the age range 42 - 85 years , were included after r and omization in a double blind , placebo controlled , crossover study of 6 months ' duration . The treatment group was given a ginger extract ( 250 mg of Zingiberis Rhizoma per capsule , qid ) , while the placebo group received the same number of identical looking capsules per day . The crossover occurred after 3 months of therapy . Results were evaluated by a 100 mm visual analog scale ( VAS ) of pain on movement and of h and icap . RESULTS Eight patients dropped out because of inefficacy , three from group 1 ( ginger extract first ) and five from group 2 ( placebo first ) . One patient from group 1 and one from group 2 dropped out because of heartburn ( while they were on ginger extract ) . Twenty patients completed the study period of 24 weeks and 19 that of 48 weeks follow-up . By the end of 24 weeks there was a highly statistically significant difference between the VAS of pain and h and icap of the two groups ( P<0.001 ) . However , at crossover both groups showed a statistically significant decrease in VAS of pain on movement and of h and icap , but the differences between the groups did not reach statistical significance . CONCLUSIONS Zintona EC was as effective as placebo during the first 3 months of the study , but at the end of 6 months , 3 months after crossover , the ginger extract group showed a significant superiority over the placebo group INTRODUCTION Although vitamin C is essential for the formation of collagen and proteoglycan and has been shown to minimise surgically induced arthritis in guinea pigs , no controlled trial has examined its effect on human osteoarthritis . MATERIAL AND METHODS The trial was a multicenter , double-blind , r and omised , placebo-controlled , crossover-trial performed by ten general practitioners . The Dec 
    Output:
    
Moderate evidence was found for methylsulfonylmethane and SKI306X , a cocktail of plant extracts .
Overall , scientific evidence exists for some specific nutritional interventions to provide symptom relief to osteoarthritic patients .
It remains to be investigated whether nutritional compounds can have structure-modifying effects