***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 study the natural history of peripheral joint osteoarthritis ( OA ) and assess its impact over eight years in a prospect i ve study of 500 patients . METHODS 500 consecutive patients with peripheral joint OA were recruited from a hospital-based rheumatology clinic . All were invited for review 3 and 8 years after entry . Joint sites involved , pain severity , change in index joints , global change in the condition , use of medication , surgery and walking aids were all recorded at each visit , and after eight years disability was assessed by the  health assessment question naire ( HAQ ) and  anxiety and depression by the Hospital anxiety and depression scale ( HAD ) . RESULTS At eight-year review , 349 patients were seen : 90 % of those remaining alive . Outcome was heterogeneous . Sixty patients ( 17.2 % ) reported worsening in all three subjective parameters ( pain , index joint and global change ) compared with 22 ( 6.3 % ) who improved in all three parameters . Using this definition of worsening or improvement , strong baseline predictors of clinical outcome did not emerge . For further description , the group was split according to the index joint sites involved at entry to the study , there being 111 with knee OA alone , 87 with h and and knee OA , 72 with h and disease alone , and 29 with hip disease alone . Forty-four percent of those with lone h and disease at entry had acquired significant knee or hip OA 8 years later . The mean HAQ and HAD scores at 8 years were high , especially in those with knee disease , indicating significant disability as a result of the disease . Those with knee or knee and h and disease had the worst outcome in all parameters recorded . The data showed a general decrease in use of NSAIDs over the eight years , but an increase in utilization of analgesics , surgery ( especially for hip disease ) and walking aids . CONCLUSIONS Patients with peripheral joint OA of sufficient severity to lead to hospital referral have a heterogeneous , but generally bad outcome over 8 years , the disease result ing in high levels of physical disability , anxiety and depression , with a high level of utilization of healthcare re sources , including joint replacement , drugs and walking aids . The results were consistent with previous suggestions that peripheral joint OA in older people is characterized by the slow acquisition of new joint sites . Progression and outcome may depend on a complex set of psychosocial factors , as well as biological ones INTRODUCTION To evaluate the efficacy of a self-management support program including a 6 week self-management course , individualised phone support and goal setting in osteoarthritis patients on a waiting list for arthroplasty surgery . METHOD R and omised controlled trial of 152 public hospital out patients awaiting hip or knee replacement surgery who were not classified as requiring urgent surgery . Participants were r and omised to a self-management program or to usual care .  The primary outcome was change in the Health Education Intervention Question naire ( HeiQ ) from r and omisation to 6 month follow-up . Quality of life and depressive symptoms were also measured . Changes in pain and function were assessed using the Western Ontario and McMaster Universities ( WOMAC ) Arthritis Index . RESULTS At 6 month follow-up , health-directed behaviour was significantly greater in the intervention [ mean 4.29 , 95 % confidence interval ( CI ) 3.99 - 4.58 ] than the control ( mean 3.81 , 95 % CI 3.52 - 4.09 ; P=0.017 ) . There was also a significant effect on skill and technique acquisition for the intervention ( mean 4.37 , 95 % CI 4.19 - 4.55 ) in comparison to control ( mean 4.11 , 95 % CI 3.93 - 4.29 ; P=0.036 ) . There was no significant effect of the intervention on the remaining HeiQ subscales , WOMAC pain or disability , quality of life or depressive symptoms . DISCUSSION The arthritis self-management program improved health-directed behaviours , skill acquisition and stiffness in patients on a joint replacement waiting list , although the observed effects were of modest size ( Cohen 's d between 0.36 and 0.42 ) . There was no significant effect on pain , function or quality of life in the short term . Self-management programs can assist in maintaining health behaviours ( particularly walking ) in this patient group . Further research is needed to assess their impact on quality of life and over longer periods Background This study examined the impact of a home-based self-management intervention for housebound older adults with arthritis on the adoption of health behaviors . The moderating role of socio-demographic , psychological , and physical characteristics in the process of behavior change was also investigated . Methods Participants were 113 older adult women ( n = 102 ) and men ( n = 11 ) with osteoarthritis ( OA ) or rheumatoid arthritis ( RA ) who were r and omly assigned to experimental ( n = 68 ) or wait list control ( n = 45 ) groups . Participants were interviewed using st and ardized question naires at baseline , pre-intervention , and post-intervention . Results Adjusted multilevel modeling analyses indicated that from pre to post intervention , experimental participants significantly increased their weekly frequency of exercise and relaxation activities . Socioeconomic status and depression played a moderating role in this change for exercise with larger effects occurring among more privileged , non-depressed participants . Conclusion We conclude that a self-management intervention can successfully improve involvement in exercise and relaxation among housebound older adults with arthritis There is limited underst and ing of how comorbid health conditions affect osteoarthritis (OA)-related outcomes . This study examined associations of different comorbidity measures with baseline OA-related patient-reported outcomes ( PROs ) among patients with hip and knee OA . Data were from patients ( N = 300 , 9 % female , mean age = 61.1 ; SD = 9.2 ) enrolled in a r and omized control trial at the Durham Veterans Affairs Medical Center . Separate multivariable regression models , adjusted for demographic and clinical characteristics , examined the association of each comorbidity measure with baseline PROs : pain , physical function , depressive symptoms , fatigue , and insomnia . Comorbidity measures included the Self-Administered Comorbidity Question naire ( SACQ ) , conditions reported as activity-limiting ( SACQ-AL ) , and indicators of depression , diabetes , hypertension , and back pain . Mean ( SD ) numbers of comorbid conditions and activity-limiting conditions were 3.4 ( 1.8 ) and 1.6 ( 1.4 ) , respectively . Comorbidity scores  ( SACQ overall and SACQ-AL ) and individual comorbidity conditions were each associated with worse OA-related PROs adjusting for demographic and clinical factors . Worse SACQ overall and SACQ-AL scores were associated with worse mean scores for pain , depressive symptoms , fatigue , and insomnia ( p values < 0.01 ) . Additionally , increasing SACQ-AL scores were associated with worse mean scores for function ( p < 0.01 ) . Depression was associated with worse pain ( p = 0.03 ) , fatigue , and insomnia ( p values < 0.01 ) . Diabetes was associated with worse fatigue ( p = 0.01 ) , depressive symptoms ( p = 0.02 ) , and insomnia ( p = 0.03 ) . Back pain was associated with worse pain scores ( p = 0.02 ) . Results provide evidence that comorbidity burden , particularly activity-limiting conditions , is associated with worse OA-related PROs . Interventions for patients with OA need to address comorbid conditions and their impact on key outcomes UNLABELLED A major goal of osteoarthritis ( OA ) treatment is pain management to improve function and maximise quality of life .  Rofecoxib is a highly selective inhibitor of cyclooxygenase-2 used in symptomatic treatment of inflammation and pain in patients with osteoarthritis of the hip or knee . AIM The primary aim of this study was to assess the effects of rofecoxib on quality of life in elderly patients with painful osteoarthritis flares of the hip or knee , who were not responsive to or had adverse reactions to previous NSAID therapy . In addition the switch pattern of NSAIDs in these patients was recorded . METHODS A 3-week prospect i ve open label multicentre study with rofecoxib 25 mg daily in 134 male and female out patients with painful osteoarthritis flares of the knee or the hip ( mean age 69 years , SD + 8) . On day 1 the patients were all switched from their previous NSAID to rofecoxib , followed by continuous daily treatment with rofecoxib 25 mg daily over 3 weeks . On day 21 the patients discontinued daily treatment with rofecoxib and had the choice between either staying on rofecoxib , switching back to their previous NSAID , trying another NSAID or stopping drug treatment . The impact on quality of life was measured by the difference in SF-12 between day 0 and day 21 . Further endpoints included changes in self-reported pain , stiffness and functional ability as measured by the WOMAC index ( Western Ontario McMaster Universities Osteoarthritis Index ) . Correlation studies were performed between the WOMAC pain subscale and quality of life as measured by the SF-12 at baseline and over the course of the study . Patients ' report of general health status and overall assessment of pain intensity , as measured by visual analogue scale ( VAS ) , was correlated with physicians ' and patients ' assessment of the efficacy of rofecoxib treatment . RESULTS Quality of life improved with rofecoxib : the physical component summary score ( SF-12 PCS ) was improved by a statistically significant + 16.2 % ( p < 0.0001 ) after 3 weeks , while the mental health component summary score ( MCS ) was improved by + 3.0 % ( n.s . ) . Disease-specific symptoms measured by the WOMAC question naire were significantly improved under rofecoxib after 3 weeks : pain decreased by 29 % ( p < 0.0001 ) and stiffness by 25 % ( p < 0.0001 ) , while functional ability increased by 24 % ( p < 0.0001 ) . The improvement in SF-12 PCS correlated negatively with the decrease in WOMAC scores ( r = -0.54 , p < 0.0001 ; r = -0.46 , p < 0.0001 and r = -0.64 , p < 0.0001 respectively ) . General health was significantly improved by + 30.5 % ( or 15.96 mm , p < 0.0001 ) between baseline and day 21 , while pain was significantly reduced by -35.2 % ( or 17.67 mm , p < 0.0001 ) on the VAS scales . At the end of the 3-week study 75 % of the patients and 84 % of the treating physicians rated the efficacy of rofecoxib from good to excellent . Two weeks after study end the planned telephone survey revealed that 54 % of the patients preferred to stay on therapy with rofecoxib , 19 % had decided to switch back to their previous NSAID ( this observation being most marked for diclofenac , where 38 % of initial diclofenac patients had decided to switch back to their initial therapy ) , 9 % had been switched to another NSAID and 7.5 % had discontinued treatment . The switch pattern is unknown in the remaining 7.5 % . CONCLUSION Rofecoxib significantly improves quality of life , as measured by the SF-12 , in OA patients who were either unresponsive to or presented with adverse reactions to previous NSAID therapy ( including celecoxib ) . In addition , rofecoxib significantly improved pain , stiffness and function , as assessed by the WOMAC question naire BACKGROUND pain is the leading symptom of osteoarthritis ( OA ) and is often chronic in nature , leading to significant morbidity and decreased quality of life . Duloxetine , a selective serotonin norepinephrine reuptake inhibitor has been demonstrated to have a central ly acting analgesic effect . OBJECTIVES the aim of the present study was to investigate the efficacy of duloxetine in reducing pain in older adults with knee OA . METHODS totally , 288 patients aged 65 years and above with primary knee OA were enrolled in this study . Patients were r and omised 1:1 . Totally , 144 received 60 mg/day of duloxetine HCL and 144 received placebo for 16 weeks . Outcome measures included pain reduction and improvement in physical functioning scores . Pain was assessed using the visual analogue pain scale ( VAS ; 0 - 100 mm ) . The Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) scores were used to assess function . RESULTS two-hundred and seventy four of the 288 patients completed the study . There was a statistically significant reduction in pain and a significant improvement in WOMAC scores at 16 weeks in the duloxetine group versus the placebo group . No serious side effects were reported . CONCLUSIONS the findings of the present study provide evidence for the efficacy and tolerability of duloxetine in reducing pain and subsequently improving function in older adults with knee OA . TRIAL REGISTRATION NCT01425827 AIM To explore general practitioners ' ( GPs ) management of  osteoarthritis ( OA ) .  BACKGROUND OA represents a large burden on primary care . Little is known about GPs ' current management of OA , especially influences on their prescribing quality care and the barriers 
    Output:
    
Patients with OA diagnosed with these comorbidities experienced more pain , had frequent hospital visits , took more medication , and reported less optimal outcomes .
Anxiety and depression adversely impact the QoL of patients with OA .