***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: We report the results of a double-blind three-centre study , employing a cross-over design , set up to compare the efficacy of intra-articular injections of Myc 2095 ( 20 mg ) , triamcinolone hexacetonide ( Lederspan ) ( 20 mg ) and placebo in 40 patients with synovitis of the knee joint . Each patient included in the study contributed data on 2 of the 3 treatment variables being compared . Seven clinical parameters were assessed every 6 weeks , while the doctor 's and the patient 's assessment s were scored . Intra articular treatment both with Myc 2095 and triamcinolone hexacetonide proved to be effective .  Placebo response was also very high . After the first Myc 2095 injection , improvement in " tenderness " , " pain under load " and " swelling and hydrops " was significantly superior to that following placebo treatment . The evaluation of the second injections indicated a marked carry-over effect from the first course . This was also evident from the doctor 's and patient 's assessment s. The importance of including a placebo in the evaluation of anti-phlogistic drugs in clinical trials , emerged from this study Background : Since the good effect of intra‐articular injections of the 5‐HT3 receptor antagonist tropisetron in patients with arthritides and activated osteoarthritis has already been demonstrated in pilot studies , the effect of tropisetron is compared with that of methylprednisolone here . Objectives : In a double‐blind study , 34 patients with gonarthritides or activated osteoarthritis ( 18 patients with rheumatoid arthritis , 16 patients with osteoarthritis ) were treated with a single intra‐articular injection of 10 mg tropisetron ( 18 patients ) or 40 mg methylprednisolone ( 16 patients ) . Before treatment as well as one and three weeks later , the intensity of rest pain and pain following exercise was measured with the visual analog scale ( VAS ) for pain and the clinical findings in the knee joint were recorded . Results : By means of the intra‐articular tropisetron treatment , the inflammatory joint process with arthritides and activated arthroses could be influenced in a similar way as with corticosteroid treatment . No significant differences were detected . Conclusion : According to the results presented here , the intra‐articular treatment with the 5‐HT3 receptor antagonist tropisetron in patients with gonarthritides and activated arthroses was about equally effective as those for treatment with corticosteroids . Therefore , it can be used as an alternative in patients for whom concomitant diseases like diabetes and hypertension make it difficult to use corticosteroids . Whether increasing the tropisetron dose may further improve the results remains to be determined in future studies The natural course of  primary osteoarthritis of the knee with or without treatment by intraarticular corticosteroid injections  was investigated in 446 patients presenting from 1970 to 1973 . Sixty-one of these patients were able to be followed up in 1982 and were divided into two groups . One group included 53 patients ( 82 knees ) without corticosteroid injections .  The other group had eight patients ( 14 knees ) who received intraarticular steroids  ( mean number of injections : 25 ; range:4 - 78 ) . The st and ing femorotibial angle at followup in the male patients receiving injections ( p < 0.05 ) was four degrees of greater varus angulation . Radiographic degeneration was more advanced in 11 of the 24 steroid-treated knees ( 78.6 % ) , and in 43 of the 82 knees without steroid injections ( 52.4 % ) ( p < 0.01 ) The index for hip disease ( ISH ) was established , vali date d and appraised as a new assessment test for the trial of new drugs as well as for long-term follow-up of patients , and to help with future indications for surgery . The ISH deals with pain , maximum walking distance , and some activities of daily living . Inter-observer reproducibility is good ( mean deviation 0.55 points ; p less than 0.05 ) . In a short-term , double-blind crossover trial , the ISH , judged according to its power to distinguish between the active drug period and the placebo period , appears as one of the best assessment tests . In the long term , total hip prosthesis is most often justified when the ISH score reaches 10 - 12 points . The index of severity for knee disease ( ISK ) was vali date d and appraised by the same statistical methods . Its value in non-steroidal anti-inflammatory drug ( NSAID ) or analgesic trials is lower than the value of the ISH . However , its use is still justified for that purpose , and for long-term follow-up of osteoarthritis of the knee Background : Although both corticosteroid and hyaluronic acid injections are widely used to palliate the symptoms of knee osteoarthritis , little research involving a comparison of the two interventions has been done . We tested the hypothesis that there are no significant differences between Hylan G-F 20 ( Synvisc ) and the corticosteroid betamethasone sodium phosphate-betamethasone acetate ( Celestone Soluspan ) in terms of pain relief or improvement in function , as determined by vali date d scoring instruments . Methods : One hundred patients with knee osteoarthritis were r and omized to receive intra-articular injection of either Hylan G-F 20 or the corticosteroid , and they were followed for six months . The patients treated with Hylan G-F 20 received one course of three weekly injections . The patients treated with the corticosteroid received one injection at the time of enrollment in the study , and they could request one more injection any time during the study . An independent , blinded evaluator assessed the patients with the Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) , a modification of the Knee Society rating system , and the visual analog pain scale . Results : Both the group treated with the corticosteroid and the group treated with Hylan G-F 20 demonstrated improvements from baseline WOMAC scores ( a median decrease from 55 to 40 points and from 54 to 44 points , respectively ; p < 0.01 for both ) . The scores according to the Knee Society system did not significantly improve for the patients who received the corticosteroid ( median , 58 to 70 points ; p = 0.06 ) or for those who received Hylan G-F 20 ( median , 58 to 68 points ; p = 0.15 ) . The scores on the visual analog scale improved for patients receiving Hylan G-F 20 ( median , 70 to 52 mm ; p < 0.01 ) but not for the patients who received the corticosteroid ( median , 64 to 52 mm ; p = 0.28 ) . However , no significant differences between the two treatment groups were found with respect to the WOMAC , Knee Society system , or visual analog scale results . Women demonstrated a significant improvement in only one of the six possible outcome -treatment combinations ( the WOMAC scale ) , whereas men demonstrated significant improvements in five of the six outcomes ( all measures except the Knee Society rating system ) . Conclusions : No differences were detected between patients treated with intra-articular injections of Hylan G-F 20 and those treated with the corticosteroid with respect to pain relief or function at six months of follow-up . Women demonstrated significantly less response to treatment than men did for both treatments on all three outcome scales . Such significant gender-related differences warrant further investigation . Level of Evidence : Therapeutic study , Level I-1b ( r and omized controlled trial [ no significant difference but narrow confidence intervals ] ) . See Instructions to Authors for a complete description of levels of evidence Within the context of a double blind r and omized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs , we vali date d WOMAC , a new multidimensional , self-administered health status instrument for patients with osteoarthritis of the hip or knee . The pain , stiffness and physical function subscales fulfil conventional criteria for face , content and construct validity , reliability , responsiveness and relative efficiency . WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials Thirty-seven patients suffering from sustained gonitis with recurrent hydrops , not satisfactorily controlled by systemic treatment , participated in the study . Twenty-three patients had bilateral and fourteen patients had unilateral gonitis . Controls were obtained through the use of the contra-lateral knee joint in the twenty-three patients with bilateral gonitis . A total of 60 knees were r and omized into three groups of 20 knees and received either 30 mg triamcinolone hexacetonide ( TH ) , 60 mg methylprednisolone ( MP ) or 9 mg betamethasone ( BM ) . The clinical parameters evaluated were : recurrence of hydrops , pain , local tenderness , range of joint movement and joint circumference . The period of time elapsing between the injection and the need for a new injection or other treatment was used as the criterion for the duration of effect . Relief lasting for an average of 176 days was obtained in the 20 knees treated with local injections of TH , compared to 125 days for MP and 79 days for BM . No general or local adverse effects were noted in the patients studied . The observed long duration of effect and the absence of adverse effects justify the use of TH in cases of therapy-refractory gonitis Intra-articular injection of micro-crystalline corticosteroid is used to treat symptomatic osteoarthritis ( OA ) of the knee , but its duration of effect and efficacy are uncertain . From the observation that pain in OA of the knee can often be blocked by infiltration of the soft tissues at the patella margin with local anaesthetic , this study investigated an injection technique in which corticosteroid was infiltrated around the patella . Thirty-eight patients with radiologically demonstrable and painful OA of the knee were treated either with peripatellar or intra-articular methylprednisolone in a r and omised double blind study . Assessment s of response to either injection were made at one week , one month and three months . Eleven of 15 measures improved significantly over time in both groups , but the differences between groups were not statistically significant . Analysis of individual responses showed that the majority of good outcomes were in the peripatellar group . Five patients receiving intra-articular injections but only one receiving a peripatellar injection withdrew because of treatment failure . Peripatellar injection is an alternative method of local administration of corticosteroid which is highly effective in a proportion of patients and merits further evaluation 
    Output:
    
AUTHORS ' CONCLUSIONS The short-term benefit of IA corticosteroids in treatment of knee OA is well established , and few side effects have been reported .
The response to HA products appears more durable .