***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: Aims The aim of this study was to evaluate the effects of using a portable , accelerometer‐based surgical navigation system ( KneeAlign2 ) in total knee arthroplasty ( TKA ) on the alignment of the femoral component , and blood loss . Patients and Methods A total of 241 consecutive patients with primary osteoarthritis of the knee were enrolled in this prospect i ve , r and omised controlled study . There were 207 women and 34 men . The mean age of the patients was 74.0 years ( 57 to 89 ) . The KneeAlign2 system was used for distal femoral resection in 121 patients ( KA2 group ) and a conventional intramedullary femoral guide was used in 120 patients ( IM group ) . Results One patient ( 0.8 % ) in the KA2 group and 19 in the IM group had an alignment which was > 3 ° away from the neutral mechanical axis ( p < 0.01 ) . The mean deviation from neutral alignment was 1.01 ° ( st and ard deviation ( sd ) 1.0 ° ) in the KA2 group and 1.93 ° ( SD 1.7 ° ) in the IM group ( p < 0.01 ) . Blood loss was significantly less in the KA2 group compared with the IM group ( 784 ml ( SD 357 ) versus 1071 ml ( SD 310 ) , p < 0.001 ) . Conclusion The KneeAlign2 system provides a technically straightforward method for identifying the femoral head and performing an accurate distal femoral resection at TKA with significantly less blood loss compared with a conventional intramedullary guide Objective To evaluate the efficacy , safety and dose response of a novel oral Janus kinase inhibitor , peficitinib ( ASP015 K ) , as monotherapy in Japanese patients with moderate to severe rheumatoid arthritis ( RA ) . Methods In a 12-week , double-blind study , 281 adult patients with RA with active disease not on concomitant disease-modifying antirheumatic drug therapy were r and omised equally to once-daily placebo or peficitinib 25 , 50 , 100 and 150 mg . The primary endpoint was American College of Rheumatology ( ACR ) 20 response in the peficitinib treatment groups versus placebo at week 12 . Results Mean age was 53.0 years , 81.1 % were female and 25.3 % had previously used antitumour necrosis factor therapy .  Peficitinib 50 , 100 and 150 mg each showed statistically significantly higher ACR20 response rates compared with placebo , and response rates increased up to 150 mg with a statistically significant dose response . The total incidence of treatment-emergent adverse events ( TEAEs ) was similar between the placebo ( 64.3 % ) and peficitinib 25 , 50 , 100 and 150 mg groups ( 70.9 % , 64.9 % , 52.7 % and 67.2 % , respectively ) . TEAEs occurring more frequently in the peficitinib group compared with the placebo group included nasopharyngitis , increased blood creatine phosphokinase and diarrhoea . No cases of serious infections were reported . Herpes zoster occurred in four patients ( two each in peficitinib 25 and 100 mg ) . Conclusions Treatment with peficitinib as monotherapy for 12 weeks in Japanese patients with moderate to severe RA is efficacious and showed acceptable safety profile . These findings support further developments of peficitinib for RA treatment . Trial registration number NCT01649999 ; Results The objective of this study was to investigate the safety and efficacy of a dietary supplement , Arthrem , containing an extract from the medicinal plant Artemisia annua , on pain , stiffness , and functional limitation in osteoarthritis ( OA ) of the hip or knee . Forty-two patients were r and omized to one of three groups ( n = 14 in each group ) : 150-mg Artemisia annua extract ( ART ) twice daily ( BD ) ( ART low dose ) , 300-mg ART BD ( ART high dose ) , or placebo BD administered over 12 weeks . Efficacy was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ® ) and visual analog scale ( VAS ) for pain . Participants treated with ART low dose demonstrated significant improvement in WOMAC total scores from baseline to 12 weeks ( mean change , −12.2 ; st and ard deviation , [ SD ] 13.84 ; p = 0.0159 ) ; improvement was not shown in the placebo group ( mean change , −7.8 ; SD , 19.80 ; p = 0.1029 ) . Statistically significant reductions were seen from baseline in the ART low-dose group for individual WOMAC components stiffness and physical function . VAS pain scores were statistically significantly reduced from baseline to 12 weeks in the ART low-dose group ( mean change , −21.4 mm ; SD , 23.48 mm ; p = 0.0082 ) but not the placebo group ( mean change , −11.5 mm ; SD , 28.97 mm , p = 0.1757 ) . No statistically significant changes occurred from baseline in the placebo or ART high-dose groups for any parameter . ART low dose was well tolerated . ART has potential as an anti-inflammatory/analgesic in OA . Treatment with ART 150 mg BD is associated with clinical ly relevant reductions in pain over 12 weeks . Further studies are warranted Background Baricitinib is an oral , reversible , selective Janus kinase 1 and 2 inhibitor . Methods In this phase III , double-blind 24-week study , 684 biologic disease-modifying antirheumatic drug (DMARD)-naïve patients with rheumatoid arthritis and inadequate response or intolerance to ≥1 conventional synthetic DMARDs were r and omly assigned 1:1:1 to placebo or baricitinib ( 2 or 4 mg ) once daily , stratified by region and the presence of joint erosions . Endpoint measures included American College of Rheumatology 20 % response ( ACR20 , primary endpoint ) , Disease Activity Score ( DAS28 ) and Simplified Disease Activity Index ( SDAI ) score ≤3.3 . Results More patients achieved ACR20 response at week 12 with baricitinib 4 mg than with placebo ( 62 % vs 39 % , p≤0.001 ) . Compared with placebo , statistically significant improvements in DAS28 , SDAI remission , Health Assessment Question naire-Disability Index , morning joint stiffness , worst joint pain and worst tiredness were observed . In a supportive analysis , radiographic progression of structural joint damage at week 24 was reduced with baricitinib versus placebo . Rates of adverse events during the treatment period and serious adverse events ( SAEs ) , including serious infections , were similar among groups ( SAEs : 5 % for baricitinib 4 mg and placebo ) . One patient had an adverse event of tuberculosis  ( baricitinib 4 mg ) ; one patient had an adverse event of non-melanoma skin cancer  ( baricitinib 4 mg ) . Two deaths and three major adverse cardiovascular events occurred ( placebo ) . Baricitinib was associated with a decrease in neutrophils and increases in low-density and high-density lipoprotein . Conclusions In patients with rheumatoid arthritis and an inadequate response or intolerance to conventional synthetic DMARDs  , baricitinib was associated with clinical improvement and inhibition of progression of radiographic joint damage . Trial registration number NCT01721057 ; Results Objective : To evaluate the feasibility of conducting a r and omized controlled trial comparing group-based outpatient physiotherapy with usual care in patients following total knee replacement . Design : A feasibility study for a r and omized controlled trial . Setting : One secondary -care hospital orthopaedic centre , Bristol , UK . Participants : A total of 46 participants undergoing primary total knee replacement . Interventions : The intervention group were offered six group-based exercise sessions after surgery . The usual care group received st and ard postoperative care . Participants were not blinded to group allocation . Outcome measures : Feasibility was assessed by recruitment , reasons for non-participation , attendance , and completion rates of study question naires that included the Lower Extremity Functional Scale and Knee Injury and Osteoarthritis Outcome Score . Results : Recruitment rate was 37 % . Five patients withdrew or were no longer eligible to participate . Intervention attendance was high ( 73 % ) and 84 % of group participants reported they were ‘ very satisfied ’ with the exercises . Return of study question naires at six months was lower in the usual care ( 75 % ) than in the intervention group ( 100 % ) . Mean ( st and ard deviation ) Lower Extremity Functional Scale scores at six months were 45.0 ( 20.8 ) in the usual care and 57.8 ( 15.2 ) in the intervention groups . Conclusion : Recruitment and retention of participants in this feasibility study was good . Group-based physiotherapy was acceptable to participants . Question naire return rates were lower in the usual care group , but might be enhanced by telephone follow-up . The Lower Extremity Functional Scale had high responsiveness and completion rates . Using this outcome measure , 256 participants would be required in a full-scale r and omized controlled trial Background In osteoarthritis ( OA ) treatment , although chondroitin sulfate ( CS ) was found in a number of studies using radiography to have a structure-modifying effect , to date CS use is still under debate . A clinical study using quantitative magnetic resonance imaging ( qMRI ) is therefore of the utmost importance . Here we report data from a 24-month , r and omised , double-blind , double-dummy , controlled , comparative exploratory study of knee OA . The primary endpoint was to determine the effect of CS 1200 mg/day versus celecoxib 200 mg/day on cartilage volume loss ( CVL ) in the lateral compartment over time as measured by qMRI . Secondary endpoints included assessment of the OA structural changes and signs and symptoms of OA . Methods qMRI was performed at baseline and at 12 and 24 months . CVL , bone marrow lesion size , and synovial thickness were evaluated using qMRI . The primary statistical analysis was carried out on the modified intention-to-treat ( mITT ) population ( n = 138 ) using chi-squared , Fisher ’s exact , Wilcoxon Mann – Whitney , and Student ’s t tests and analysis of covariance . Analyses were also conducted on the according-to- protocol ( ATP ; n = 120 ) population . Results In the adjusted mITT analysis , compared with celecoxib treatment , patients treated with CS had a significant reduced CVL at 24 months in the medial compartment ( celecoxib –8.1 % ± 4.2 , CS –6.3 % ± 3.2 ; p = 0.018 ) and medial condyle ( –7.7 % ± 4.7 , –5.5 % ± 3.9 ; p = 0.008 ) ; no significant effect was seen in the lateral compartment . In the ATP population , CS reduced CVL in the medial compartment at 12 months ( celecoxib –5.6 % ± 3.0 , CS –4.5 % ± 2.6 ; p = 0.049 ) and 24 months ( celecoxib –8.4 % ± 4.2 , CS –6.6 % ± 3.3 ; p = 0.021 ) , and in the medial condyle at 24 months ( celocoxib –8.1 % ± 4.7 , CS –5.7 % ± 4.0 ; p = 0.010 ) . A trend towards a statistically reduced synovial thickness  ( celecoxib + 17.96 ± 33.73 mm , CS –0.66 ± 22.72 mm ; p = 0.076 ) in the medial suprapatellar bursa was observed in CS patients . Both groups experienced a marked reduction in the incidence of patients with joint swelling/effusion and in symptoms over time . Data showed similar good safety profiles including cardiovascular adverse events for both drugs . Conclusion This study demonstrated , for the first time in a 2-year r and omised controlled trial using qMRI , the superiority of CS over celecoxib at reducing CVL in knee OA patients .Trial registration Clinical Trials.gov NCT01354145 . Registered 13 May 2011 Objectives : To determine whether prolonged intensive disease-modifying antirheumatic drug ( DMARD ) treatment ( PRINT ) leads to high remission and low relapse rates in patients with severe rheumatoid arthritis ( RA ) . Methods : In this multicenter , r and omized and parallel treatment trial , 346 patients with active RA ( disease activity score ( 28 joints ) [ DAS28 ] ( erythrocyte sedimentation rate [ ESR ] ) > 5.1 ) were enrolled from 9 centers . In phase 1 , patients received intensive treatment with methotrexate , leflunomide , and hydroxychloroquine , up to 36 weeks , until remission ( DAS28 �� 
    Output:
    
While women are adequately represented in RA and OA trials , the elderly are underrepresented , probably limiting applicability of current evidence to this growing subgroup .