***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 Evaluation of patients with osteoarthritis includes the assessment of pain , functional disability , and radiographically-detectable lesions . The physical and psychological consequences of this disease on patients ' quality of life are not clearly understood . The aim of this study was to determine the changes in quality of life among osteoarthritis patients after celecoxib treatment . METHODS The SF-36 Quality of Life question naire was used in this prospect i ve multicenter study to evaluate changes in pain intensity and quality of life in 2339 patients with osteoarthritis treated by 1244 general practitioners with celecoxib ( 200 mg per day ) for 4 weeks .  Pain intensity was measured with a visual analogue scale . The suitability of the SF-36 for such an evaluation was also studied , as was tolerance of the medication . RESULTS After 4 weeks of celecoxib treatment , 8 of the 9 domains of the SF-36 question naire showed significant improvement , with an effect size > 0.40 , especially for " limitations due to physical health " and " limitations due to pain " . Pain intensity decreased from 66.5+/-12.2 mm at inclusion to 34.0+/-18.7 mm at the final visit . Both patients and physicians found the question naire suitable for assessing the quality of life of osteoarthritis patients . The side effects reported were consistent with the drug 's known tolerance profile . CONCLUSION This study shows that the quality of life improved in patients with osteoarthritis after 4 weeks of celecoxib treatment , in the physical as well psychological and social domains . The SF-36 question naire proved to be a suitable instrument for measuring quality of life in these patients , and its use in the management of patients with osteoarthritis in general medicine should be encouraged Objective : To compare the efficacy of etoricoxib , lumiracoxib , celecoxib , non-selective ( ns ) NSAIDs and acetaminophen in the treatment of osteoarthritis ( OA ) Methods : R and omized placebo controlled trials investigating the effects of acetaminophen 4000 mg , diclofenac 150 mg , naproxen 1000 mg , ibuprofen 2400 mg , celecoxib 100 - 400 mg , lumiracoxib 100 - 400 mg , and etoricoxib 30 - 60 mg with treatment duration of at least two weeks were identified with a systematic literature search . The endpoints of interest were pain , physical function and patient global assessment of disease status ( PGADS ) . Pain and physical function reported on different scales ( VAS or LIKERT ) were translated into effect sizes ( ES ) . An ES 0.2 - 0.5 was defined as a “ small ” treatment effect , whereas ES of 0.5 – 0.8 and > 0.8 were defined as “ moderate ” and “ large ” , respectively . A negative effect indicated superior effects of the treatment group compared to the control group . Results of all trials were analyzed simultaneously with a Bayesian mixed treatment comparison . Results : There is a > 95 % probability that etoricoxib ( 30 or 60 mg ) shows the greatest improvement in pain and physical function of all interventions compared . ESs of etoricoxib 30 mg relative to placebo , celecoxib 200 mg , ibuprofen 2400 mg , and diclofenac 150 mg were -0.66 ( 95 % Credible Interval -0.83 ; -0.49 ) , -0.32 ( -0.50 ; -0.14 ) , -0.25 ( -0.53 ; 0.03 ) , and -0.17 ( -0.41 ; 0.08 ) , respectively . Regarding physical functioning , ESs of etoricoxib 30 mg relative to placebo , celecoxib 200 mg , ibuprofen 2400 mg , and diclofenac 150 mg were -0.61 ( -0.76 ; -0.46 ) , -0.27 ( -0.43 ; -0.10 ) , -0.20 ( -0.47 ; 0.07 ) , and -0.09 ( - 0.33 ; 0.14 ) respectively . The greatest improvements in PGADS were expected with either etoricoxib or diclofenac . Conclusion : The current study estimated the efficacy of acetaminophen , nsNSAIDs , and COX-2 selective NSAIDs in OA and found that etoricoxib 30 mg is likely to result in the greatest improvements in pain and physical function . Differences in PGADS between interventions were smaller BACKGROUND Acetaminophen ( paracetamol ) is recommended as the initial pharmacological treatment for knee or hip osteoarthritis . However , survey and clinical trial data indicate greater efficacy for non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 specific inhibitors . DESIGN Two r and omised , double blind , placebo controlled , crossover multicentre clinical trials , Patient Preference for  Placebo , Acetaminophen or Celecoxib Efficacy Studies ( PACES ) . PATIENTS Osteoarthritis of knee or hip . INTERVENTION " Wash out " of treatment ; r and omisation ; 6 weeks of celecoxib 200 mg/day , acetaminophen 1000 mg four times a day , or placebo ; second " wash out ; " crossover to 6 weeks of second treatment . MEASUREMENTS Western Ontario McMaster Osteoarthritis Index ( WOMAC ) , visual analogue pain scale , patient preference between two treatments . RESULTS Celecoxib was more efficacious than acetaminophen in both periods in both studies ; WOMAC and pain scale scores differed at p<0.05 in period II and both periods combined of PACES-a and in periods I and II and both periods combined in PACES-b , but not in period I of PACES-a . Acetaminophen was more efficacious than placebo , generally p<0.05 in PACES-b , and > 0.05 in PACES-a . Patient preferences were 53 % celecoxib v 24 % acetaminophen in PACES-a ( p<0.001 ) and 50 % v 32 % in PACES-b ( p = 0.009 ) ; 37 % acetaminophen v 28 % placebo in PACES-a ( p = 0.340 ) and 48 % v 24 % in PACES-b ( p = 0.007 ) . No clinical ly or statistically significant differences were seen in adverse events or tolerability among the three treatment groups . CONCLUSIONS Greater efficacy was seen for celecoxib v acetaminophen v placebo , while adverse events and tolerability were similar . Variation in results and statistical significance in the two different trials are of interest OBJECTIVE To compare the efficacy and safety of celecoxib , a cyclooxygenase-2 ( COX-2 ) inhibitor , with those of naproxen , a nonsteroidal anti-inflammatory drug ( NSAID ) , and placebo in the treatment of osteoarthritis of the knee . METHODS In this multicenter , r and omized , double-blind , placebo-controlled trial , 1003 patients with symptomatic osteoarthritis of the knee were r and omly assigned to receive celecoxib at doses of 50 , 100 , or 200 mg twice a day ; naproxen , 500 mg twice a day ; or placebo for 12 weeks . Patients were evaluated with st and ard measures of efficacy 2 to 7 days after discontinuing previous NSAID or analgesic therapy and after 2 , 6 , and 12 weeks of treatment with the study drug . RESULTS Celecoxib treatment led to significant improvement in the signs and symptoms of osteoarthritis as determined by all efficacy measures . Significant pain relief occurred within 2 days of the initiation of treatment , and maximum anti-inflammatory and analgesic activity , evident within 2 weeks , was sustained throughout the 12-week study . All celecoxib doses were efficacious compared with placebo , although the 50-mg twice-daily dosage regimen was minimally effective . The higher doses of celecoxib ( 100 and 200 mg twice a day ) were similarly efficacious , and the magnitude of improvement observed with these dosing regimens was comparable to that seen with naproxen at a dose of 500 mg twice a day . All doses of celecoxib and naproxen were well tolerated . CONCLUSION COX-2 inhibition with celecoxib is an effective approach for the treatment of osteoarthritis , as seen by clinical improvement in signs and symptoms comparable to treatment with naproxen Background Current use of prescribed or over the counter non-steroidal anti-inflammatory drugs ( NSAIDs ) for pain and osteoarthritis ( OA ) have untoward gastrointestinal and cardiovascular related side effects , as a result the need for a safe and effective alternative has become unequivocally crucial . Method A r and omized , double blind , placebo and active controlled pilot study of a novel dual pathway , COX1/2 and LOX , inhibitor anti-inflammatory agent of botanical origin , UP446 was conducted . Sixty subjects ( age 40 - 75 ) with symptomatic OA of the hip or knee were assigned to 4 treatment groups ( n = 15 ) ; Group A0 ( Placebo , CMC capsule ) , Group A1 ( UP446 250 mg/day ) , Group A2 ( UP446 500 mg/day ) and Group A3 ( Celecoxib , 200 mg/day ) . MOS-SF-36 and Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) data were collected at baseline and after 30 , 60 and 90 days of treatment as a measure of efficacy . Erythrocyte sedimentation rate , C-reactive protein , plasma thrombin time ( PTT ) , fructosamine , Hematology , clinical chemistry and fecal occult blood were monitored for safety . Results Statistically significant decrease in WOMAC pain score were observed for Group A1 at day 90 , Group A2 at 30 and 90 days and Group A3 at 60 and 90 days . Statistically significant decrease in WOMAC stiffness score were observed for Group A1 and Group A2 at 30 , 60 and 90 days ; but not for Group A0 and Group A3 . The mean change in WOMAC functional impairment scores were statistically significant for Group A1 and Group A2 respectively at 30 days ( p = 0.006 and p = 0.006 ) , at 60 days ( p = 0.016 and p = 0.002 ) and at 90 days ( p = 0.018 and p = 0.002 ) , these changes were not significant for Group A0 and Group A3 . Based on MOS -SF-36 question naires , statistically significant improvements in physical function , endurance and mental health scores were observed for all active treatment groups compared to placebo . No significant changes suggestive of toxicity in routine hematologies , serum chemistries , liver enzymes or PTT were noted in any of the treatment groups . Conclusion Based on current findings UP446 is safe and efficacious alternative to established anti-inflammatory medications for alleviating OA symptoms as measured by the WOMAC Index BACKGROUND Glucosamine and chondroitin sulfate are used to treat osteoarthritis . The multicenter , double-blind , placebo- and celecoxib-controlled Glucosamine/chondroitin Arthritis Intervention Trial ( GAIT ) evaluated their efficacy and safety as a treatment for knee pain from osteoarthritis . METHODS We r and omly assigned 1583 patients with symptomatic knee osteoarthritis to receive 1500 mg of glucosamine daily , 1200 mg of chondroitin sulfate daily , both glucosamine and chondroitin sulfate , 200 mg of celecoxib daily , or placebo for 24 weeks . Up to 4000 mg of acetaminophen daily was allowed as rescue analgesia . Assignment was stratified according to the severity of knee pain ( mild [ N=1229 ] vs. moderate to severe [ N=354 ] ) . The primary outcome measure was a 20 percent decrease in knee pain from baseline to week 24 . RESULTS The mean age of the patients was 59 years , and 64 percent were women . Overall , glucosamine and chondroitin sulfate were not significantly better than placebo in reducing knee pain by 20 percent . As compared with the rate of response to placebo ( 60.1 percent ) , the rate of response to glucosamine was 3.9 percentage points higher ( P=0.30 ) , the rate of response to chondroitin sulfate was 5.3 percentage points higher ( P=0.17 ) , and the rate of response to combined treatment was 6.5 percentage points higher ( P=0.09 ) . The rate of response in the celecoxib control group was 10.0 percentage points higher than that in the placebo control group ( P=0.008 ) . For patients with moderate-to-severe pain at baseline , the rate of response was significantly higher with combined therapy than with placebo ( 79.2 percent vs. 54.3 percent , P= 
    Output:
    
This improvement may not be clinical ly significant ( low quality evidence due to missing data and few participants ) ( 1 study , 264 participants ) .Based on low or very low quality evidence ( down grade d due to missing data , high risk of bias , few events and wide confidence intervals ) results were inconclusive for withdrawals due to AEs ( Peto OR 0.97 , 95 % CI 0.74 to 1.27 ) , number of participants experiencing SAEs ( Peto OR 0.92 , 95 % CI 0.66 to 1.28 ) , gastro-intestinal events ( Peto OR 0.61 , 0.15 to 2.43 ) and cardiovascular events ( Peto OR 0.47 , 95 % CI 0.17 to 1.25).In comparisons of celecoxib and placebo there were no differences in pooled analyses between our main analysis with low risk of bias and all eligible studies .
Current evidence indicates that celecoxib is slightly better than placebo and some tNSAIDs in reducing pain and improving physical function .