***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 BACKGROUND SKI306X , which consists of biologically active ingredients from Clematis m and sburica , Tricbosantbes kirilowii , and Prunella vulgaris , was developed and tested in pre clinical trials in Korea . Those studies found that SKI306X was associated with an anti-inflammatory and analgesic effect , and that it can delay the destruction of cartilage in rheumatoid arthritis ( RA ) . OBJECTIVE The aim of this study was to compare the pain relief and tolerability of SKI306X and celecoxib in patients with RA . METHODS This study was a 6-week , multicenter , r and omized , double-blind , double-dummy , Phase III , noninferiority clinical trial . Eligible patients were aged 18 to 80 years , had a history of RA with a disease duration of > or =3 months , and were functional American College of Rheumatology ( ACR ) class I , II , or III before entry . After a washout period of 2 weeks , patients were r and omized to SKI306X 200 mg TID or celecoxib 200 mg BID for 6 weeks . The primary end point was a change in patient assessment of pain intensity using a visual analog scale ( VAS ) . The secondary end points were a 20 % improvement in response rate as defined by the ACR ( ACR20 ) and the frequency of rescue medication use . Results after 3 and 6 weeks of treatment were compared with baseline and between treatment groups , and all patients were assessed for adverse events ( AEs ) , clinical laboratory data , and vital signs . AEs were identified based on spontaneous reports by patients during interviews conducted by the investigators and the study coordinator . RESULTS Two hundred twenty-two Korean patients from 7 medical centers were assessed and 183 were enrolled and r and omized to 1 of 2 treatment groups . Ninety-one patients ( 10 male , 81 female ; mean [ SD ] age , 52.13 [ 12.64 ] years ; mean [ SD ] duration of RA , 9.08 [ 10.23 ] years ; no. [ % ] of ACR class I , II , and III , 13 [ 14.29 ] , 44 [ 48.35 ] and 34 [ 37.36 ] patients , respectively ) received SKI306X 200 mg TID and 92 patients ( 10 male , 82 female ; mean [ SD ] age , 51.78 [ 10.94 ] years ; mean [ SD ] duration of RA , 8.78 [ 7.78 ] years ; no. [ % ] of ACR class I , II , and III , 14 [ 15.22 ] , 44 [ 47.83 ] , and 34 [ 36.96 ] patients , respectively ) received celecoxib 200 mg BID . An analysis of the change in reported pain intensity as determined by VAS ( mm ) score between baseline and week 3 ( mean [ SD ] , 13.64 [ 16.62 ] vs 14.45 [ 15.89 ] ) , and between baseline and week 6 ( 18.4 [ 20.8 ] vs 17.9 [ 19.1 ] , respectively ) suggested that SKI306X was not inferior to celecoxib . The number of patients who achieved ACR20 response rate was not significantly different between the SKI306X group and the celecoxib group at week 3 ( 16/87 [ 18.4 % ] vs 24/87 [ 27.6 % ] , respectively ) and at week 6 ( 29/87 [ 33.3 % ] vs 29/87 [ 33.3 % ] ) . The frequency of rescue medication use was not significantly different between the SKI306X group and celecoxib group at week 3 ( 54/87 [ 62.1 % ] vs 47/87 [ 54.0 % ] , respectively ) or week 6 ( 57/87 [ 65.5 % ] vs 49/87 [ 56.3 % ] ) . Drug-related AEs were reported by 27 ( 29.7 % ) patients in the SKI306X group and 22 ( 23.9 % ) patients in the celecoxib group . The most frequent drug-related AEs were epigastric pain ( 9/91 [ 9.9 % ] ) in the SKI306X group and glutamyltranferase elevation ( 4/92 [ 4.3 % ] ) in the celecoxib group . No significant between-group differences were observed in the prevalence of drug-related clinical - or laboratory-determined AEs . CONCLUSION The results of this study suggest that SKI306X was generally well tolerated and not inferior to celecoxib in regard to pain relief in these Korean patients with RA Rheumatoid arthritis ( RA ) is the most common chronic inflammatory disease with unknown causes and unknown cures in Western medicine . This double-blinded study aim ed to investigate the efficacy and safety of a widely used traditional Chinese medicine ( Paeoniflorin ( PAE ) plus cervus and cucumis polypeptide injection ( CCPI ) using disease-modifying antirheumatic drugs ( DMARD ) as a control ( methotrexate ( MTX ) plus leflunomide ( LEF ) ) .  Patients were r and omly assigned to one of the three groups : PAE + CCPI , MTX + LEF , and MTX + LEF + CCPI . The primary end point was the American College of Rheumatology 20 % improvement response criteria ( ACR20 ) . The secondary end point was that of adverse effect frequencies and the speed of onset action . Our results showed that more patients in the CCPI-containing groups responded to the ACR20 during early treatment . After six months , ACR20 showed no significant difference among the three treatments . The maximum improvement in the two DMARD groups was significantly higher than that in the PAE + CCPI group ( p < 0.01 ) . CCPI made the onset action of the DMARD therapy 4.6 times faster . PAE + CCPI had significantly lower adverse event incidences than the two DMARD groups . These results indicate that PAE + CCPI appear to be a more acceptable alternative to DMARDs when patients can not use DMARDs . CCPI appears to be a beneficial add-on to DMARDs that makes the onset of action faster , especially when patients need to relieve RA symptoms as soon as possible . Although not as effective as DMARDs , PAE appears to be a safer option to substitute DMARDs for long-term RA treatment when DMARD toxicity is an issue OBJECTIVE To observe the therapeutic effect of Yangxue Tongluo Recipe ( YTR ) combined with immunosuppressive agents in the treatment of rheumatoid arthritis ( RA ) . METHODS Totally 88 RA patients were r and omly assigned to the treatment group [ 47 cases , YTR combined Methotrexate ( MTX ) + Leflunomide ( LEF ) treatment ] and the control group ( 41 cases , MTX + LEF therapy ) . All patients received 12-week treatment . Clinical symptoms and signs , laboratory tests [ erythrocyte sedimentation rate ( ESR ) , rheumatoid factor ( RF ) , and C reactive protein ( CRP ) ] , and adverse reactions were observed before and after treatment . RESULTS The total effective rate was 91.5 % ( 43/47 cases ) in the treatment group , and the total effective rate was 75.6 % ( 31/41 cases ) in the control group . There was statistical difference between the two groups ( P < 0.05 ) . The morning stiffness , the rest pain , the number of tender joints , the number of swollen joints , tender joint index , swollen joint index , ESR , RF , and CRP were significantly improved in the two groups after treatment ( P < 0.01 ) . Besides , clinical symptoms and signs , ESR , RF , and CRP were more improved in the treatment group after treatment , when compared with those in the control group ( P < 0.05 ) . Gastrointestinal discomfort was the main adverse reaction in the two groups , but the occurrence was lower in the treatment group than in the control group ( P > 0.05 ) . CONCLUSIONS The clinical efficacy of YTR combined MTX + LEF in the treatment of RA was better than using Western medicine alone . It was more safe with less adverse reactions OBJECTIVE To observe the clinical efficacy and safety of Simiao Xiaobi Decoction ( SXD ) in treating active rheumatoid arthritis ( RA ) of humid pyretic toxic Bi-Zheng ( HPTB ) syndrome type . METHODS One hundred and twenty RA patients were r and omly assigned to 2 groups , 60 in the treatment group receiving SXD , and 60 in the control group receiving methotrexate , all were treated for 12 weeks . Clinical efficacy in patients was evaluated , referring to the criteria recommended by European League Against Rheumatoism ( EULAR ) , in terms of effective rate , main symptoms , signs , scoring on symptom/sign by Chinese medicine scale and DAS28 , physical and chemical indices , long-term outcome of patients and the average therapeutic effect initiating time . Meantime , the adverse reaction was recorded . RESULTS The study was completed in 103 patients , 52 in the treated group and 51 in the control group . According to a per- protocol analysis , the effective rate was better in the treatment group than in the control group with marked difference in terms of Chinese and Western medicine respectively ( 92.3 % vs 70.6 % and 86.5 % vs 62.7 % , P<0.05 ) . Superiorities in the treatment group were also seen in the improvements of main symptoms and signs , symptom/sign scores , DAS28 scores , and long-term outcome . Moreover , the average therapeutic effect initiating time was shorter ( 5.31 + /- 0.36 weeks vs 8.28 + /- 0.45 weeks ) , while the incidence of adverse reaction was less in the treatment group than in the control group ( 6.7 % vs 43.3 % , P<0.05 ) . CONCLUSION SXD can improve the joint symptoms and general condition of RA patients of HPTB type with shorter initiating time and less adverse reaction OBJECTIVE To examine the efficacy of popular Chinese herbs used in a traditional Chinese medicine ( TCM ) combination of Ganoderma lucidum and San Miao San ( SMS ) , with purported diverse health benefits including antioxidant properties in rheumatoid arthritis ( RA ) . METHODS We r and omly assigned 32 patients with active RA , despite disease-modifying antirheumatic drugs , to TCM and 33 to placebo in addition to their current medications for 24 weeks . The TCM group received G lucidum ( 4 gm ) and SMS ( 2.4 gm ) daily . The primary outcome was the number of patients achieving American College of Rheumatology ( ACR ) 20 % response and secondary outcomes included changes in the ACR components , plasma levels , and ex vivo-induced cytokines and chemokines and oxidative stress markers . RESULTS Eighty-nine percent completed the 24-week study . Fifteen percent in the TCM group compared with 9.1 % in the placebo group achieved ACR20 ( P > 0.05 ) . Pain score and patient 's global score improved significantly only in the TCM group . The percentage , absolute counts , and CD4+/CD8+/natural killer/B lymphocytes ratio 
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In multivariable analysis , fewer authors were associated with selection bias ( allocation concealment ) , performance bias and attrition bias , and earlier year of publication and funding source not reported or disclosed were associated with selection bias ( sequence generation ) .
Studies published in non-English language were associated with reporting bias .
Studies evaluating CHM often fail to meet expected method ological criteria , and high- quality evidence is lacking