***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: BACKGROUND Bodily pain and physical disability can negatively impact health-related quality of life ( HRQL ) in patients with osteoarthritis ( OA ) . OBJECTIVE To assess the effects of treatment with a new agent , rofecoxib , on HRQL in patients with OA . STUDY DESIGN R and omized , double-blind , 6-week clinical trial comparing treatment with rofecoxib , 5 to 50 mg , with placebo in 672 patients with OA of the hip or knee . MAIN OUTCOME MEASURE Patient HRQL was assessed at baseline and at the end of treatment using the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) . RESULTS At 6 weeks , mean change from baseline in all SF-36 mental and physical health domain scores demonstrated significant improvement with rofecoxib use ( P < .05 for all doses for all SF-36 domains ) , with evidence of a dose-response relation . Improvements in mental and physical HRQL domains with rofecoxib treatment were significantly greater than those with placebo treatment ( P < .05 for each dose of rofecoxib vs placebo for all domains except general health ) and highly correlated with improvements observed using disease-specific OA outcome measures such as the Western Ontario and McMaster Universities Osteoarthritis Index-visual Analog 3.0 OA index pain and physical function subscales . The effect of rofecoxib vs placebo treatment on mental health largely disappeared after adjustment for improvement in OA disease-specific measures . CONCLUSIONS Rofecoxib treatment increased physical and mental HRQL domain scores on the SF-36 . Improvements in mental health with rofecoxib use primarily result ed from effective treatment of OA ( i.e. , reduction in pain and improvement in physical function ) 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 assess the prevalence of rheumatic diseases in Greek urban , suburban , and rural adult general population s. METHODS This cross-sectional population based epidemiological study of rheumatic diseases in Greece ( the ESORDIG Study ) was conducted on the total adult population of 2 urban , one suburban , and 4 rural communities ( 8547 subjects ) , as well as on 2100 out of 5686 r and omly selected subjects in one suburban and one rural community . The study , based on a st and ardized question naire and clinical evaluation and laboratory investigation when necessary , was carried out by rheumatologists who visited the target population at their homes . Either established classification criteria or criteria set for the purpose s of the study were used for diagnosis . RESULTS A total of 8740 subjects participated in the study ( response rate 82.1 % ) . The overall age and sex adjusted prevalence ( prevalence(asa ) ) of rheumatic diseases in the total target adult population was 26.9 % ( 95 % CI 26.2 - 27.6 ) , being significantly higher among women ( 33.7 % ) than men ( 19.9 % ) ( p < 0.0005 ) . Disease prevalence(asa ) increased significantly with age ( p < 0.0005 ) . The most common disease group was low back pain , with a prevalence(asa ) of 11.0 % , followed by symptomatic peripheral osteoarthritis ( 7.9 % ) , neck pain ( 4.8 % ) , miscellaneous rheumatic disorders ( 4.4 % ) , soft tissue rheumatism disorders ( 4.3 % ) , and inflammatory rheumatic disease ( 2.1 % ) . Logistic regression analysis showed a significant positive association of female or male sex , age > or= 50 years , high body mass index , low level of education , moderate or heavy alcohol consumption , and high socioeconomic level with particular diseases or disease groups . CONCLUSION These findings indicate rheumatic diseases are very common in the general adult population of Greece ; 26.9 % of adults currently have active or chronic rheumatic disease in remission 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 OBJECTIVE --To assess the efficacy of a single intra-articular injection of triamcinolone hexacetonide ( THA ) in knee osteoarthritis ( OA ) and examine factors which may relate to treatment efficacy . METHODS --Eighty four patients with clinical and radiographic evidence of knee OA were recruited and r and omly allocated to receive either THA ( 20 mg in 1 ml ) or placebo ( 0.9 % normal saline , 1 ml ) . Follow up assessment s evaluated the following outcome variables : patient opinion of overall change in the treated knee , visual analogue pain score ( VAS ) , distance walked in one minute ( WD ) , and Health Assessment Question naire modified for lower limb function ( HAQ ) . RESULTS --Seventy eight percent of THA and 49 % of placebo treated patients reported overall improvement at week 1 ( p < 0.05 ) . At week 6 , improvement was reported in 57 % and 55 % of patient groups , respectively . VAS improved in both groups at week 1 ( THA , p < 0.001 ; placebo , p < 0.05 ) and week 6 ( both p < 0.01 ) . Improvement in VAS was significantly greater among THA treated patients at week 1 only ( p < 0.01 ) . Subgroup analysis of THA treated patients revealed greater improvement in VAS among patients with clinical evidence of an effusion ( p < 0.05 ) , and those who had synovial fluid successfully aspirated at the time of injection ( p < 0.01 ) . WD improved in THA treated patients at week 1 ( p < 0.001 ) , and in both groups at week 6 ( THA , p < 0.001 ; placebo , p < 0.01 ) . Improvements in HAQ were seen in THA patients only at weeks 1 and 6 ( p < 0.05 ) . Regression analysis did not identify any additional clinical , radiographic , or synovial fluid characteristics which influenced the response . CONCLUSIONS --THA provided short term pain relief in knee OA . Increased benefit was associated with both clinical evidence of joint effusion and successful aspiration of synovial fluid at the time of injection 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=0.002 ) . Adverse events were mild , infrequent , and evenly distributed among the groups . CONCLUSIONS Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee . Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain . ( Clinical Trials.gov number , NCT00032890 . ) OBJECTIVES A r and omized , placebo-controlled , double-blind trial of the relative effectiveness of glucosamine sulphate and placebo in managing pain in osteoarthritis ( OA ) of the knee . METHODS Eighty patients with OA of the knee were recruited from a rheumatology out-patient clinic and received either glucosamine sulphate 1500 mg daily for 6 months or dummy placebo . The primary outcome measure was patients ' global assessment of pain in the affected knee . RESULTS Area under the curve analysis for the primary outcome measure showed no difference between placebo and glucosamine [ mean difference 0.15 mm , 95 % confidence interval ( CI ) -8.78 to 9.07 ] . The placebo response was 33 
    Output:
    
Clinical effects from pharmacological interventions in OAK are small and limited to the first 2 - 3 weeks after start of treatment .
The pain-relieving effects over placebo in OAK are smaller than the patient-reported thresholds for relevant improvement