***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 The efficacy , tolerance , and safety of CPH 82 ( semisynthetic lignan glycosides ) ( Conpharm AB ) for patients with rheumatoid arthritis ( RA ) were assessed in a 12-week double-blind placebo-controlled study . Thirteen patients out of 15 in the CPH 82 group and 10 out of 15 in the placebo group completed the study .  No improvement was seen in placebo treated patients . Patients treated with CPH 82 showed a statistically significant improvement in most clinical and immunological variables . Some patients treated with CPH 82 reported gastrointestinal discomfort ( diarrhoea and abdominal pain ) In rheumatoid arthris s various pro-inflammatory metabolites of arachidonic acid ( AA ) , such as leukotriene B4 ( LTB4 ) and prostagl and in E2 ( PGE2 ) , contribute to tissue destruction and pain . In contrast to AA , which is an omega-6 fatty acid , the omega-3 fatty acids , after having been liberated from the cell membrane phospholipids , are further converted into the non-or anti-inflammatory eicosanoids LTB5 and PGI3 . AA concentration is an important regulatory step in the synthesis of both prostanoids and leukotriens . Dietary supplementation with eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) has therefore been used to decrease the ratio of AA to EPA or DHA to obtain beneficial clinical effects . EPA and DHA are found in animal fat and are quite expensive compared to their precursor alpha-linolenic acid ( alpha-LNA ) found in flaxseed oil . We , therefore , performed a placebocontrolled trial with alpha-LNA in 22 patients with rheumatoid arthritis , using a linoleic acid preparation as a placebo . After a 3-month follow-up , the treatment group showed an increased bleeding time , but the clinical , subjective ( global assessment , classification of functional status , joint score index , visual analogue scale , pain tendereness score ) and laboratory parameters ( haemoglobin , erythrocyte sedimentation rate , C-reactive protein ) did not show any statistical alterations . AA , EPA and DHA did not change either in spite of a significant increase in alpha-LNA in the treatment group . Thus , 3-month 's supplementation with alpha-LNA did not prove to be beneficial in rheumatoid arthritis 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 The objective of this study was to assess the clinical efficacy and side effects of blackcurrant seed oil ( BCSO ) , in a r and omized , double-blind , placebo controlled , 24-week trial in patients with RA and active synovitis .  BCSO is rich in gammalinolenic acid ( GLA ) and alphalinolenic acid ( ALA ) . Both GLA and eicosapentaenoic acid which derives from ALA suppress inflammation and joint tissue injury in animal models . Treatment with BCSO result ed in reduction in signs and symptoms of disease activity in patients with RA ( P < 0.05 ) . In contrast , patients given a  placebo  showed no change in disease . Overall clinical responses ( significant change in four measures ) were no better in the treatment group than in the placebo group . No patients withdrew from BCSO treatment because of adverse reactions . However , many patients withdrew because BCSO and its placebo had to be administered in 15 large capsules daily . Nonetheless , the study indicates that BCSO is a potentially effective treatment for active RA . However , means must be found to reduce the size and number of capsules taken , so that larger studies of longer duration in RA patients can be done The neuropeptide substance P has been implicated in the pathogenesis of inflammation and pain in arthritis . In this double-blind r and omized study , 70 patients with osteoarthritis ( OA ) and 31 with rheumatoid arthritis ( RA ) received capsaicin ( a substance P depletor ) or placebo for four weeks . The patients were instructed to apply 0.025 % capsaicin cream or its vehicle ( placebo ) to painful knees four times daily . Pain relief was assessed using visual analog scales for pain and relief , a categorical pain scale , and physicians ' global evaluations . Most of the patients continued to receive concomitant arthritis medications . Significantly more relief of pain was reported by the capsaicin-treated patients than the placebo patients throughout the study ; after four weeks of capsaicin treatment , RA and OA patients demonstrated mean reductions in pain of 57 % and 33 % , respectively . These reductions in pain were statistically significant compared with those reported with placebo ( P = 0.003 and P = 0.033 , respectively ) . According to the global evaluations , 80 % of the capsaicin-treated patients experienced a reduction in pain after two weeks of treatment . Transient burning was felt at the sites of drug application by 23 of the 52 capsaicin-treated patients ; two patients withdrew from treatment because of this side effect . It is concluded that capsaicin cream is a safe and effective treatment for arthritis OBJECTIVE To evaluate RA-1 , a st and ardized plant extract formulation , traditionally considered a safe , effective antiarthritic in the Asian-Indian Ayurvedic medicinal system . METHODS One hundred eighty-two patients with active-on-chronic rheumatoid arthritis ( RA ) participated in a 16 week r and omized , double blind , placebo controlled , parallel efficacy clinical drug trial in Pune , India .  Tenderness , pain , swelling , and several other efficacy measures were assessed by ( 1 ) ACR core set 20 % and 50 % improvement ; ( 2 ) ACR 20 % improvement response . An intent-to-treat analysis was performed ; p<0.05 considered significant . RESULTS Seventeen patients withdrew ( active = 9 ; placebo = 8) ; none withdrew due to drug toxicity . An unprecedented placebo response ( often p<0.001 in within-group change ) was observed . The active RA-1 group remained numerically superior at all evaluation timepoints . RA-1 demonstrated few significant differences : ( 1 ) increased proportion with 50 % reduction in swollen joint count ( 95 % CI approximately 1.52 , 29.90 ) and swollen joint score ( 95 % CI approximately 0.91 , 28.73 ) ; ( 2 ) reduced rheumatoid factor ( 95 % CI approximately -303.7 , -2.72 ) ; 39 % in the RA-1 group versus 30 % placebo showed ACR 20 % improvement ( 95 % CI approximately -5.48 , 24.59 ) . Only minor side effects were seen , with no significant differences by treatment group . CONCLUSION In a trial with sufficient power , RA-1 revealed efficacy that was not significantly superior to the strong placebo response , except for improvement in joint swelling . Further , the effect on RF and good safety profile led to an open label phase A polyglycosides of Tripterygium wilfodii hook F ( TWH ) preparation with a code name of T2 is used in the present double-blind , controlled , cross-over study on the treatment of 70 cases of rheumatoid arthritis ( RA ) . An impressive curative effect of T2 is confirmed much more convincingly by the present study than that by the previously reported clinical open trials . The adverse reactions and the probable pharmacological mechanism of T2 are also discussed In a double blind noncrossover study , dietary supplementation with fish oil ( 18 g/day ) , was compared with an olive oil supplement over a 12-week period in patients with rheumatoid arthritis receiving established conventional therapies . An improvement in tender joint score and grip strength was seen at 12 weeks in the fish oil treated group but not in the olive oil treated group . The more subjective measures of mean duration of morning stiffness and analogue pain score improved to a similar extent in both groups , although statistical significance was only achieved in paired analyses in the olive oil treated group . Production of leukotriene B4 by 
    Output:
    
RESULTS There is moderate support for gamma-linolenic acid ( GLA ) , which is found in some herbal medicines , for reducing pain , tender joint count and stiffness .
In general , herbal preparations were relatively safe to use .