***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: Objective To investigate the effects of Qingre Huoxue Decoction 清热活血方 , clearing heat and promoting blood flow ; QRHXD ) , on the radiographic progression in patients with rheumatoid arthritis ( RA ) by X-ray imaging . Methods Eighty-six patients with active RA diagnosed as damp-heat and blood stasis syndrome were r and omized into a QRHXD group and a QRHXD plus methotrexate ( MTX ) group , with 43 cases in each group . After one-year of treatment , 21 cases in each group ( 42 in total ) were evaluated . Radiographs of h and s were obtained at the baseline and after 12 months of treatment . Images were evaluated by investigators blinded to chronology and clinical data , and assessed according to the Sharp/Van der Heijde methods . Results High intrareader agreements were reached ( mean intraobserver intraclass coefficients : 0.95 ) . No significant change in any imaging parameters of joint destruction was observed at 12 months in either group ; and the differences between the two groups were not significant ( P>0.05 ) . The mean of the changing score in the QRHXD group was 3.5±4.1 , and 2.4±3.5 in the QRHXD+MTX group , while the baseline radiographic score of patients in the QRHXD group was relatively higher ( 18.9±19.1 vs. 14.0±14.0 ) . The mean rates of the changing scores of the two groups were similar ( 0.24±0.28 vs. 0.25±0.44 , P=0.40 ) . The severity of progression in the two groups was also similar ( P=0.46 ) , 7 cases without radiographic progression in the QRHXD group and 8 in the QRHXD+MTX group , 3 cases with obvious radiographic progression in the QRHXD group and 1 in the QRHXD+MTX group . Conclusion Radiographic progression of RA patients in both groups is similar , indicating that the QRHXD Decoction has a potential role in preventing bone destruction Aim To monitor joint inflammation and destruction in rheumatoid arthritis ( RA ) patients receiving adalimumab/methotrexate combination therapy using MRI and ultrasonography . To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring . Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/radiography ( 0/6/12 months ) and clinical /biochemical assessment s during adalimumab/methotrexate combination therapy . Results No overall erosion progression or repair was observed at 6 or 12 months ( Wilcoxon ; p>0.05 ) , but erosion progressors and regressors were observed using the smallest detectable change cut-off . Scores of MRI synovitis , grey-scale synovitis ( GSS ) and power Doppler ultrasonography decreased after 6 and 12 months ( p<0.05 ) , as did DAS28 , HAQ and tender and swollen joint counts ( p<0.001 ) . Patients with progression on CT had higher baseline MRI bone oedema scores . The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 ( 95 % CI 1.5 to 9.3 ) and time-integrated MRI bone oedema , power Doppler and GSS scores were higher in bones/joints with CT progression ( Mann – Whitney ; p<0.05 ) . With CT as the reference method , sensitivities/specificities for erosion in metacarpophalangeal joints were 68%/92 % , 44%/95 % and 26%/98 % for MRI , ultrasonography and radiography , respectively . Median intraobserver correlation coefficient was 0.95 ( range 0.44–0.99 ) . Conclusion During adalimumab/methotrexate combination therapy , no overall erosive progression or repair occurred , whereas repair of individual erosions was documented on MRI , and MRI and ultrasonography synovitis decreased . Inflammation on MRI and ultrasonography , especially MRI bone oedema , was predictive for erosive progression on CT , at bone/joint level and MRI bone oedema also at patient level OBJECTIVE RANKL is essential for osteoclast development , activation , and survival . Denosumab is a fully human monoclonal IgG2 antibody that binds RANKL , inhibiting its activity . The aim of this multicenter , r and omized , double-blind , placebo-controlled , phase II study was to evaluate the effects of denosumab on structural damage in patients with rheumatoid arthritis ( RA ) receiving methotrexate treatment . METHODS RA patients received subcutaneous placebo ( n = 75 ) , denosumab 60 mg ( n = 71 ) , or denosumab 180 mg ( n = 72 ) injections every 6 months for 12 months . The primary end point was the change from baseline in the magnetic resonance imaging ( MRI ) erosion score at 6 months . RESULTS At 6 months , the increase in the MRI erosion score from baseline was lower in the 60-mg denosumab group ( mean change 0.13 ; P = 0.118 ) and significantly lower in the 180-mg denosumab group ( mean change 0.06 ; P = 0.007 ) than in the placebo group ( mean change 1.75 ) . A significant difference in the modified Sharp erosion score was observed as early as 6 months in the 180-mg denosumab group ( P = 0.019 ) as compared with placebo , and at 12 months , both the 60-mg ( P = 0.012 ) and the 180-mg ( P = 0.007 ) denosumab groups were significantly different from the placebo group . Denosumab caused sustained suppression of markers of bone turnover . There was no evidence of an effect of denosumab on joint space narrowing or on measures of RA disease activity . Rates of adverse events were comparable between the denosumab and placebo groups . CONCLUSION Addition of twice-yearly injections of denosumab to ongoing methotrexate treatment inhibited structural damage in patients with RA for up to 12 months , with no increase in the rates of adverse events as compared with placebo OBJECTIVE To observe the effect of Fengshi No. 1 ( FS1 ) in treating patients with active stage of rheumatoid arthritis ( RA ) . METHODS Patients with RA were r and omly divided into two groups , the 40 patients in the treated group were treated with combined therapy of methotrexate ( MTX ) , sulfasalazine ( SSZ ) and FS1 , and the 20 in the control groups were treated with MTX and SSZ alone . RESULTS In the treated group , the total effective rate was 97.5 % , the clinical controlled and markedly effective rate 95.0 % and the occurrence rate of side-toxic reaction 10.0 % , as compared with those in the control group , 60.0 % , 20.0 % and 45.0 % respectively , the difference was significant ( chi 2 = 11.91 , 32.23 and 7.67 respectively , all P < 0.01 ) . The effect in the treated group was superior to that in the control group in abating joint swelling and pain , improving function of joint , reducing immune indices and ameliorating iconographic features ( P < 0.01 or P < 0.05 ) . CONCLUSION FS1 not only has the effects of anti-inflammation , analgesis , regulating immune reaction , but also could retard the occurring of bone destruction , reduce the toxic-side effects of MTX and SSZ Objective To observe the efficacy of Hebi Formula ( HF ) combined Methotrexate ( MTX ) on early rheumatoid arthritis ( RA ) patients with disharmony of Gan and Pi syndrome ( DGPS ) and its effects on matrix metalloproteinase-3 ( MMP-3 ) activator of nuclear factor-KB/receptor activator of nu- clear factor-KB/osteoprotegerin ( RANK/RANKL/OPG ) . Methods Totally 72 early RA patients with DGPS were assigned to the treatment group and the control group according to r and om digit table , 36 in each group . Patients in the control group took MTX , while those in the treatment group additionally took HF . MTX dose was increased from 7 . 5 mg to 12 . 5 mg gradually , once per week , and the course of treatment was 24 weeks . Efficacy for Chinese medicine ( CM ) syndromes , ACR20 improvement rate , laboratory re- lated indices [ rheumatoid factor ( RF ) , erythrocyte sedimentation rate ( ESR ) , C-reactive protein ( CRP ) , anti-cyclic citrullinated peptide antibody ( CCP ) ] , serum levels of MMP-3 , OPG , RANKL , and adverse reactions were observed . Results The st and ard arriving rate of ACR20 was 82 . 86 % ( 2935 ) in the treatment group , higher than that in the control group [ 51 . 52 % ( 173 ) ; P < 0 . 05 ) . The effective rate of CM syndrome was 85 . 7 % ( 30f35 ) in the treatment group , higher than that in the control group [ 63 . 6 % ( 21/33 ) ; P < 0 . 05 ) . Compared with before treatment in the same group , levels of RF , ESR , CRP , MMP-3 , and RANKL decreased , the OPG level increased in the two groups after treatment ( P < 0 . 05 , P < 0 . 01 ) . Compared with the control group , levels of RF , ESR , CRP , and RANKL all decreased with statistical difference ( P < 0 . 01 , P < 0 . 05 ) . Liver dysfunction occurred in 1 case of the treatment group . Leucopenia occurred in 1 case and liver dysfunction occurred in 2 cases of the control group . Conclusion HF com- bined MTX could improve symptoms of early RA patients with DGPS , and regulate bone destruction in- duced by RANK/RANKL/OPG systems 
    Output:
    
Conclusions : Chinese medicine may provide an efficiently alternative choice for the treatment of RA in terms of the bone-protecting efficiency .