***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: Forty patients with rheumatoid arthritis and upper gastrointestinal lesions due to non-steroidal anti-inflammatory drugs entered a prospect i ve 6-month double-blind placebo controlled study of dietary supplementation with gamma-linolenic acid 540 mg/day . Nineteen patients received active therapy ( as evening primrose oil 6 g/day ) and 21 received placebo ( olive oil 6 g/day ) . No patient stopped non-steroidal anti-inflammatory therapy but three patients in each group reduced their dose . Other results showed a significant reduction in morning stiffness with gamma-linolenic acid at 3 months and reduction in pain and articular index at 6 months with olive oil . Whilst gamma-linolenic acid may produce mild improvement in rheumatoid arthritis , olive oil may itself have hitherto unrecognized benefits CONTEXT Research both in the United States and abroad suggests that significant numbers of people are involved with various forms of alternative medicine . However , the reasons for such use are , at present , poorly understood . OBJECTIVE To investigate possible predictors of alternative health care use . METHODS Three primary hypotheses were tested . People seek out these alternatives because ( 1 ) they are dissatisfied in some way with conventional treatment ; ( 2 ) they see alternative treatments as offering more personal autonomy and control over health care decisions ; and ( 3 ) the alternatives are seen as more compatible with the patients ' values , worldview , or beliefs regarding the nature and meaning of health and illness . Additional predictor variables explored included demographics and health status . DESIGN A written survey examining use of alternative health care , health status , values , and attitudes toward conventional medicine . Multiple logistic regression analyses were used in an effort to identify predictors of alternative health care use . SETTING AND PARTICIPANTS A total of 1035 individuals r and omly selected from a panel who had agreed to participate in mail surveys and who live throughout the United States . MAIN OUTCOME MEASURE Use of alternative medicine within the previous year . RESULTS The response rate was 69 % . The following variables emerged as predictors of alternative health care use  : more education ( odds ratio [ OR ] , 1.2 ; 95 % confidence interval [ CI ] , 1.1 - 1.3 ) ; poorer health status ( OR , 1.3 ; 95 % CI , 1.1 - 1.5 ) ; a holistic orientation to health ( OR , 1.4 ; 95 % CI , 1.1 - 1.9 ) ; having had a transformational experience that changed the person 's worldview ( OR , 1 .8 ; 95 % CI , 1 .3 - 2.5 ) ; any of the following health problems : anxiety ( OR , 3.1 ; 95 % CI , 1.6 - 6.0 ) ; back problems ( OR , 2.3 ; 95 % CI , 1 .7 - 3.2 ) ; chronic pain ( OR , 2.0 ; 95 % CI , 1.1 -3.5 ) ; urinarytract problems ( OR , 2.2 ; 95 % CI , 1.3 - 3.5 ) ; and classification in a cultural group identifiable by their commitment to environmentalism , commitment to feminism , and interest in spirituality and personal growth psychology ( OR , 2.0 ; 95 % CI , 1.4 - 2.7 ) . Dissatisfaction with conventional medicine did not predict use of alternative medicine . Only 4.4 % of those surveyed reported relying primarily on alternative therapies . CONCLUSION Along with being more educated and reporting poorer health status , the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values , beliefs , and philosophical orientations toward health and life 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 In rheumatoid arthritis ( RA ) benefit from non-steroidal anti-inflammatory drugs ( NSAIDs ) is mediated through inhibition of the cyclo-oxygenase enzyme , thereby decreasing production of the 2 series prostagl and ins ( PGs ) . The lipoxygenase enzyme is intact , however , allowing leucotriene ( LT ) production , e.g. , LTB4 ( an inflammatory mediator ) . Treatment with evening primrose oil ( EPO ) which contains gamma-linolenic acid ( GLA ) leads to production of the 1 series PGs , e.g. , PGE1 , which has less inflammatory effects . Also LT production is inhibited . Eicosapentaenoic acid ( EPA , fish oil ) treatment provides a substrate for PGs and LTs , which are also less inflammatory . In this study 16 patients with RA were given  540 mg GLA/day ( EPO ) , 15 patients 240 mg EPA and 450 mg GLA/day ( EPO/fish oil ) , and 18 patients an inert oil ( placebo ) . The aim of this study was to determine if EPO or EPO/fish oil could replace NSAID treatment in RA . The initial 12 month treatment period was followed by three months of placebo for all groups . Results at 12 months showed a significant subjective improvement for EPO and EPO/fish oil compared with placebo . In addition , by 12 months the patients receiving EPO and EPO/fish oil had significantly reduced their NSAIDs . After 3 months of placebo those receiving active treatment had relapsed . Despite the decrease in NSAIDs , measures of disease activity did not worsen . It is suggested that EPO and EPO/fish oil produce a subjective improvement and allow some patients to reduce or stop treatment with NSAIDs . There is , however , no evidence that they act as disease modifying agents The serum concentration of lipids and composition of fatty acids after overnight fasting were studied in 18 patients with rheumatoid arthritis treated for 12 weeks with either 20 ml of evening primrose oil containing 9 % of gamma-linolenic acid or olive oil .  The serum concentrations of oleic acid , eicosapentaenoic acid , and apolipoprotein B decreased and those of linoleic acid , gamma-linolenic acid , dihomo-gamma-linolenic acid , and arachidonic acid increased during treatment with evening primrose oil . During olive oil treatment the serum concentration of eicosapentaenoic acid decreased and those of high density lipoprotein-cholesterol and apolipoprotein A-I increased slightly . The decrease in serum eicosapentaenoic acid and the increase in arachidonic acid concentrations induced by evening primrose oil may not be favourable effects in patients with rheumatoid arthritis in the light of the roles of these fatty acids as precursors of eicosanoids Feverfew , reputed by folklore to be effective in arthritis , has in vitro properties that could be beneficial in the control of inflammatory disease . Forty one female patients with symptomatic rheumatoid arthritis received either dried chopped feverfew ( 70 - 86 mg ) or placebo capsules once daily for six weeks . Allocation was r and om and not known by patient or observer . Variables assessed included stiffness , pain ( visual analogue scale ) , grip strength , articular index , full blood count , erythrocyte sedimentation rate , urea , creatinine , C reactive protein , complement breakdown products ( C3dg ) , rheumatoid factor titre , immunoglobulins ( IgG , IgA , IgM ) , functional capacity , and patient and observer global opinions . One patient ( placebo ) withdrew after three days and was not included in the analysis . Treatment and placebo groups ( 20 patients each ) were well matched at entry . No important differences between the clinical or laboratory variables of the groups were observed during the six week period . This study therefore shows no apparent benefit from oral feverfew in rheumatoid arthritis Eighty-two subjects with chronic arthritic pain were r and omly assigned for 2 months without cross-over to either Reumalex , a licenced over-the-counter ( OTC ) herbal medicine , or a placebo .  Entry characteristics were determined by a previous survey of arthritic customers at pharmacy and healthfood shop outlets . The AIMS 2 question naire was completed at monthly intervals throughout and for 2 months prior to the trial , and a modified Ritchie Index provided clinical scores . Subjects also completed diary recordings of their use of self-prescribed analgesics and events they considered significant . There was a small but statistically significant improvement in pain symptoms , less so in sufferers from osteoarthritis . There were no other significant changes in any other measures nor in the use of other self-prescribed analgesics . There were few side-effects noted . It is concluded that Reumalex has a mild analgesic effect in chronic arthritis at a level appropriate to self-medication Dietary gammalinolenic acid ( GLA ) , a potent inhibitor of 5-lipoxygenase ( 5-LOX ) and suppressor of leukotriene B4 ( LTB4 ) , can attenuate the clinical 
    Output:
    
For most HMPs used in the treatment of RA , the evidence of effectiveness was insufficient to either recommend or discourage their use .