***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: Curcumin is known to possess potent antiinflammatory and antiarthritic properties . This pilot clinical study evaluated the safety and effectiveness of curcumin alone , and in combination with diclofenac sodium in patients with active rheumatoid arthritis ( RA ) . Forty-five patients diagnosed with RA were r and omized into three groups with patients receiving curcumin ( 500 mg ) and diclofenac sodium ( 50 mg ) alone or their combination . The primary endpoints were reduction in Disease Activity Score ( DAS ) 28 . The secondary endpoints included American College of Rheumatology ( ACR ) criteria for reduction in tenderness and swelling of joint scores . Patients in all three treatment groups showed statistically significant changes in their DAS scores . Interestingly , the curcumin group showed the highest percentage of improvement in overall DAS and ACR scores ( ACR 20 , 50 and 70 ) and these scores were significantly better than the patients in the diclofenac sodium group . More importantly , curcumin treatment was found to be safe and did not relate with any adverse events . Our study provides the first evidence for the safety and superiority of curcumin treatment in patients with active RA , and highlights the need for future large-scale trials to vali date these findings in patients with RA and other arthritic conditions Background The purpose of this study was to assess the effect of 8-weeks ingestion of a commercialized joint pain dietary supplement ( InstaflexTM Joint Support , Direct Digital , Charlotte , NC ) compared to placebo on joint pain , stiffness , and function in adults with self-reported joint pain .  InstaflexTM is a joint pain supplement containing glucosamine sulfate , methylsufonlylmethane ( MSM ) , white willow bark extract ( 15 % salicin ) , ginger root concentrate , boswella serrata extract ( 65 % boswellic acid ) , turmeric root extract , cayenne , and hyaluronic acid . Methods Subjects included 100 men and women , ages 50 - 75 years , with a history ( > 3 months ) of joint pain , and were r and omized to Instaflex ™ or placebo ( 3 colored gel capsules per day for 8 weeks , double-blind administration ) . Subjects agreed to avoid the use of non-steroidal anti-inflammatory drugs ( NSAID ) and all other medications and supplements targeted for joint pain . Primary outcome measures were obtained pre- and post- study and included joint pain severity , stiffness , and function ( Western Ontario and McMaster Universities [ WOMAC ] ) , and secondary outcome measures included health-related quality of life ( Short Form 36 or SF-36 ) , systemic inflammation ( serum C-reactive protein and 9 plasma cytokines ) , and physical function ( 6-minute walk test ) . Joint pain symptom severity was assessed bi-weekly using a 12-point Likert visual scale ( 12-VS ) . Results Joint pain severity was significantly reduced in Instaflex ™ compared to placebo ( 8-week WOMAC , ↓37 % versus ↓16 % , respectively , interaction effect P = 0.025 ) , with group differences using the 12-VS emerging by week 4 of the study ( interaction effect , P = 0.0125 ) . Improvements in ability to perform daily activities and stiffness scores  in Instaflex ™ compared to placebo were most evident for the 74 % of subjects reporting knee pain ( 8-week WOMAC function score , ↓39 % versus ↓14 % , respectively , interaction effect P = 0.027 ; stiffness score , ↓30 % versus ↓12 % , respectively , interaction effect P = 0.081 ) . Patterns of change in SF-36 , systemic inflammation biomarkers , and the 6-minute walk test did not differ significantly between groups during the 8-week study Conclusions Results from this r and omized , double blind , placebo-controlled community trial support the use of the Instaflex ™ dietary supplement in alleviating  joint pain severity in middle-aged and older adults , with mitigation of difficulty performing daily activities most apparent in subjects with knee pain . Trial registration Clinical Trials.gov Identifier : Objective To determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement . Methods 367 primary knee osteoarthritis patients with a pain score of 5 or higher were r and omized to receive ibuprofen 1,200 mg/day or C. domestica extracts 1,500 mg/day for 4 weeks . The main outcomes were Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) total , WOMAC pain , WOMAC stiffness , and WOMAC function scores . Adverse events ( AEs ) were also recorded . Results 185 and 182 patients were r and omly assigned into C. domestica extracts and ibuprofen groups , respectively . The baseline characteristics were no different between groups . The mean of all WOMAC scores at weeks 0 , 2 , and 4 showed significant improvement when compared with the baseline in both groups . After using the noninferiority test , the mean difference ( 95 % confidence interval ) of WOMAC total , WOMAC pain , and WOMAC function scores at week 4 adjusted by values at week 0 of C. domestica extracts were noninferior to those for the ibuprofen group ( P=0.010 , P=0.018 , and P=0.010 , respectively ) , except for the WOMAC stiffness subscale , which showed a trend toward significance ( P=0.060 ) . The number of patients who developed AEs was no different between groups . However , the number of events of abdominal pain/discomfort was significantly higher in the ibuprofen group than that in the C. domestica extracts group ( P=0.046 ) . Most subjects ( 96%–97 % ) were satisfied with the treatment , and two-thirds rated themselves as improved in a global assessment . Conclusion C. domestica extracts are as effective as ibuprofen for the treatment of knee osteoarthritis . The side effect profile was similar but with fewer gastrointestinal AE reports in the C. domestica extracts group In a previous three-month study of Meriva , a proprietary curcumin-phosphatidylcholine phytosome complex , decreased joint pain and improvement in joint function were observed in 50 osteoarthritis ( OA ) patients . Since OA is a chronic condition requiring prolonged treatment , the long-term efficacy and safety of Meriva were investigated in a longer ( eight months ) study involving 100 OA patients . The clinical end points ( Western Ontario and McMaster Universities [ WOMAC ] score , Karnofsky Performance Scale Index , and treadmill walking performance ) were complemented by the evaluation of a series of inflammatory markers ( interleukin [IL]-1beta , IL-6 , soluble CD40 lig and [ sCD40L ] , soluble vascular cell adhesion molecule (sVCAM)-1 , and erythrocyte sedimentation rate [ ESR ] ) . This represents the most ambitious attempt , to date , to evaluate the clinical efficacy and safety of curcumin as an anti-inflammatory agent . Significant improvements of both the clinical and biochemical end points were observed for Meriva compared to the control group . This , coupled with an excellent tolerability , suggests that Meriva is worth considering for the long-term complementary management of osteoarthritis Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials Background We previously developed a surface-controlled water-dispersible form of curcumin and named it Theracurmin ® ( Theracurmin ; Theravalues , Tokyo , Japan ) . The area under the blood concentration – time curve of Theracurmin in humans was 27-fold higher than that of curcumin powder . We determined the clinical effects of orally administered Theracurmin in patients with knee osteoarthritis during 8 weeks of treatment . Methods Fifty patients with knee osteoarthritis of Kellgren – Lawrence grade II or III and who were aged more than 40 years were enrolled in this r and omized , double-blind , placebo-controlled , prospect i ve clinical study . Placebo or Theracurmin containing 180 mg/day of curcumin was administered orally every day for 8 weeks . To monitor adverse events , blood biochemistry analyses were performed before and after 8 weeks of each intervention . The patients ’ knee symptoms were evaluated at 0 , 2 , 4 , 6 , and 8 weeks by the Japanese Knee Osteoarthritis Measure , the knee pain visual analog scale ( VAS ) , the knee scoring system of the Japanese Orthopedic Association , and the need for nonsteroidal anti-inflammatory drugs . Results At 8 weeks after treatment initiation , knee pain VAS scores were significantly lower in the Theracurmin group than in the placebo group , except in the patients with initial VAS scores of 0.15 or less . Theracurmin lowered the celecoxib dependence significantly more than placebo . No major side effects were observed with Theracurmin treatment . Conclusion Theracurmin shows modest potential for the treatment of human knee osteoarthritis This retrospective observational study summarizes the experiences of 820 patients treated with a new Curcuma extract ( Flexofytol ® , 4 - 6 capsules per day ) , for more than 6 months for various forms of painful osteoarthritis . These experiences were reported by 110 Belgian general practitioners via a question naire that included quality -of-life parameters for assessing patient experience . Data were su bmi tted to an independent statistician for analysis . Within the first 6 weeks , Flexofytol ® improved patient pain , articular mobility , and quality of life . Excellent tolerance was reported , and more than half of these patients were able to discontinue analgaesic and anti-inflammatory drugs . Patient satisfaction was confirmed by their decision to maintain Flexofytol ® therapy for more than 6 months . These data must be confirmed with r and omized controlled studies . We currently conclude that Flexofytol ® which is based on a new preparation of curcumin , is as a potential neutraceutical for the care of patients complaining of joint problems , with excellent tolerance and rapid benefits for articular mobility , pain , and quality of life Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Nonsteroidal anti-inflammatory Drugs ( NSAIDs ) is one of the most commonly use medication for treatment of knee osteoarthritis which has the analgesic and anti-inflammation by inhibition of prostagl and in synthesis via COX-1 and COX-2 isoenzyme . The problem of prolong using NSAIDs has side effect on kidney , liver and GI system . Curcumin longa extract Curcumin ) is the Asian herbal medicine that has the anti-inflammatory effect by down regulate activation of NF-kappaB and proinflammatory cytokines such as Tumor Necrotic Factor-alpha , Interleukin-1 , Interleukin-8 , and Nitric Oxide Syntase . Many research data had advocate for the combination therapy which can increase safety and efficacy with less side effect compare with monotherapy regimen especially when the medicine has the different mechanism of action . The present study is the double blind prospect i ve r and omized control trial to evaluate the efficacy of curcumin as an adjuvant therapy of diclofenac in primary knee osteoarthritis . 44 patients were r and omized to take NSAIDs ( diclofenac ) 75 mg/d with placebo and the other 44 took NSAIDs ( diclofenac ) 75 mg/d with curc 
    Output:
    
There were significantly fewer effects on pain relief , knee stiffness and physical function with curcuminoids compared with ibuprofen .
Significant improvements in Western Ontario and McMaster Universities Arthritis Index total scores , with significant reductions in the use of rescue medication were also observed with curcuminoids .
No serious adverse events were reported .
Curcuminoids may have some beneficial effects on knee pain and quality of life in patients with knee OA .
However , they are less effective at relieving pain compared with ibuprofen .
Curcuminoids appear safe on the short-term , and may reduce the need for rescue medication .