***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: BACKGROUND Plaque psoriasis of mild to moderate severity is routinely treated with topical steroids and coal tar along with emollients . A safe and convenient new treatment modality would be of value to most patients with psoriasis . OBJECTIVE Our purpose was to evaluate the safety and efficacy of a new vitamin D3 analogue , calcipotriene , for the treatment of plaque psoriasis . METHODS Twice-daily dosing of calcipotriene was compared with its vehicle , for up to 8 weeks , in a double-blind study of 277 patients at 10 study centers in the United States . Two hundred forty-seven patients completed the trial . The clinical characteristics of plaque elevation , erythema , scaling , and overall disease severity were evaluated at baseline and after 1 , 2 , 4 , 6 , and 8 weeks of treatment . A Physician 's Global Assessment of improvement or worsening of the disease was performed after 1 , 2 , 4 , 6 , and 8 weeks of treatment . Blood and urine sample s , for routine clinical laboratory tests , were collected at baseline and after 1 , 2 , 4 , and 8 weeks of treatment . RESULTS As early as the week 1 evaluation , patients treated with calcipotriene ointment 0.005 % had significantly lower mean scores ( p = 0.043 ) than the vehicle-treated patients for the disease characteristics of plaque elevation , erythema , and scaling . This trend continued through week 8 of treatment when 70 % of the calcipotriene-treated patients showed 75 % or more improvement compared with only 19 % of vehicle-treated patients . Only minor treatment-related adverse events were observed . There were no abnormal laboratory results judged related to treatment and the rare instances of elevated serum calcium values were equally distributed between active and vehicle treatments . CONCLUSION This study provides evidence that calcipotriene is a safe , effective , and promising new agent for the treatment of moderately severe plaque psoriasis OBJECTIVES To evaluate further in a phase III , double blind trial the efficacy of infliximab in patients with active psoriatic arthritis ( PsA ) , as observed in the smaller IMPACT trial . METHODS 200 patients with active PsA unresponsive to previous treatment were r and omised to infusions of infliximab 5 mg/kg or placebo at weeks 0 , 2 , 6 , 14 , and 22 . Patients with inadequate response entered early escape at week 16 . The primary measure of clinical response was ACR20 . Other measures included Psoriatic Arthritis Response Criteria ( PsARC ) , Psoriasis Area and Severity Index ( PASI ) , and dactylitis and enthesopathy assessment s. RESULTS At week 14 , 58 % of patients receiving infliximab and 11 % of those receiving placebo achieved an ACR20 response and 77 % of infliximab patients and 27 % of placebo patients achieved PsARC ( both p<0.001 ) . Among the 85 % of patients with at least 3 % body surface area psoriasis involvement at baseline , 53/83 ( 64 % ) patients receiving infliximab had at least 75 % improvement in PASI compared with 2/87 ( 2 % ) patients receiving placebo at week 14 ( p<0.001 ) . These therapeutic effects were maintained through the last evaluation ( week 24 ) . Fewer infliximab patients than placebo patients had dactylitis at week 14 ( 18 % v 30 % ; p = 0.025 ) and week 24 ( 12 % v 34 % ; p<0.001 ) . Fewer infliximab patients ( 22 % ) than placebo patients ( 34 % ) had active enthesopathy at week 14 ( p = 0.016 ) ; corresponding figures at week 24 were 20 % and 37 % ( p = 0.002 ) . Infliximab was generally well tolerated , with a similar incidence of adverse events in each group . CONCLUSIONS Infliximab 5 mg/kg through 24 weeks significantly improved active PsA , including dactylitis and enthesopathy , and associated psoriasis There are few ' second-line ' drugs available for the treatment of PSA and their use is often limited by toxicity .  Thirty-nine patients with active PSA recruited from two rheumatology units were r and omly allocated to either enteric-coated sulphasalazine ( SASP ) or placebo and followed for 24 wk . Six patients in the SASP group and 11 on placebo discontinued therapy before 24 wk . Evaluation of effect of treatment revealed significant improvements in articular index in both groups at 12 wk . By 24 wk the articular index in placebo group was still showing benefit . In addition to articular index the SASP group improved significantly in terms of visual analogue scale , duration of morning stiffness and ESR .  SASP is effective in PSA but the partial clinical response to placebo indicates the importance of placebo-controlled studies in this variable disease OBJECTIVE To determine if the peripheral articular manifestations of the seronegative spondylarthropathies ( SNSA ) respond differently than the axial manifestations to treatment with sulfasalazine ( SSZ ) . METHODS This is a re analysis of a previously reported series of r and omized , double-blind , placebo-controlled , multicenter trials comparing the effects of SSZ , 2,000 mg/day , and placebo on the axial and peripheral articular manifestations of ankylosing spondylitis ( AS ) , psoriatic arthritis ( PsA ) , and reactive arthritis ( ReA ; Reiter 's syndrome ) . Patients were classified as treatment responders on the basis of meeting predefined improvement criteria in 4 outcome measures : namely , patient and physician global assessment s in all patients , morning stiffness and back pain in patients with axial manifestations , and joint pain/tenderness scores and joint swelling scores in patients with peripheral articular manifestations . RESULTS Six hundred nineteen SNSA patients ( 264 AS , 221 PsA , and 134 ReA ) were studied . One hundred eighty-seven of these patients had only axial manifestations of their disease , while 432 patients had peripheral articular manifestations . Of the patients with axial disease , 40.2 % of the SSZ group and 43.3 % of the placebo group met the predefined response criteria ( P = 0.67 ) . Of the peripheral articular group , 59.0 % of the SSZ-treated patients and 42.7 % of the placebo-treated patients showed a response ( P = 0.0007 ) . CONCLUSION In a large group of affected individuals , the response of SNSA patients to SSZ appears to be related to the articular manifestations of their disease . These data demonstrate that the axial and peripheral articular manifestations of SNSA respond differently to treatment with SSZ . In SNSA patients with persistently active peripheral arthritis , SSZ is safe , well tolerated , and effective The efficacy and safety of the oral gold compound auranofin and intramuscular gold thiomalate have been compared in a placebo-controlled , double-blind , four-centre trial in 82 patients with psoriatic arthritis requiring remittive drug therapy . There were statistically significant falls in Ritchie articular index , visual analogue pain score and ESR at 12 and 24 weeks following i.m . gold but no significant changes in the auranofin group . Intramuscular gold was safe and more effective than auranofin as a second-line , suppressive antirheumatic agent for patients with psoriatic arthritis when followed for 6 months A r and omized , double‐blind , left‐right , vehicle‐controlled study to assess the therapeutic efficacy and safety of twice daily application of 15 μg/g calcitriol ointment for a period of 6 weeks was performed in 32 patients suffering from bilateral , symmetrical , severe chronic plaque psoriasis OBJECTIVE To compare the efficacy and tolerability of cyclosporine ( CSA ) with that of symptomatic therapy ( ST ) alone and sulfasalazine ( SSZ ) in the treatment of psoriatic arthritis ( PsA ) . METHODS Twelve rheumatology centers recruited 99 patients with active PsA in a 24 week , prospect i ve , r and omized , open , controlled study . The patients were treated with CSA ( 3 mg/kg/day ) or SSZ ( 2,000 mg/day ) plus ST , or ST alone ( nonsteroidal antiinflammatory drugs , analgesics , and /or prednisone < or = 5 mg/day ) . The primary endpoint was the 6 month change in pain . Analyses were on the basis of the intention-to-treat principle . RESULTS In comparison with both SSZ and ST , there was a statistically significant difference in favor of CSA in terms of the mean changes in the pain score ( p < 0.05 ) , which was considered the primary response variable . A significant decrease in favor of CSA versus ST alone was also observed for swollen joint count ( p = 0.05 ) , tender joint count ( p = 0.01 ) , joint/pain tenderness score ( p = 0.002 ) , patient and physician global assessment by at least one point ( p = 0.04 and 0.01 , respectively ) , total Arthritis Impact Measurement Scale score ( p = 0.002 ) , and spondylitis functional index ( p = 0.002 ) . There was a statistically significant difference in the ACR 50 % and ACR 70 % response rates between the CSA and ST groups ( p = 0.02 , 0.05 ) . Comparing the SSZ and ST alone groups , only the spondylitis functional index decreased significantly in the SSZ treated patients ( p = 0.03 ) . The Psoriasis Area and Severity Index was significantly lower in the CSA than in the ST and SSZ groups ( p = 0.0001 and 0.01 , respectively ) . Decrease in erythrocyte sedimentation rate was significant only in the SSZ versus the ST group ( p = 0.02 ) , whereas reduction in C-reactive protein was significant in the CSA treated patients compared with the ST group ( p = 0.006 ) . The most common adverse event in the CSA group was mild , reversible kidney dysfunction . CONCLUSION The results of this open trial confirm that CSA is well tolerated by patients with PsA and suggest that it is more efficacious than ST or SSZ OBJECTIVE To evaluate the efficacy and safety of alefacept in combination with methotrexate ( MTX ) for the treatment of psoriatic arthritis ( PsA ) . METHODS Patients were eligible for this r and omized , double-blind , placebo-controlled trial if they were ages 18 - 70 years and had active PsA ( > or = 3 swollen joints and > or = 3 tender joints ) despite treatment with MTX for > or = 3 months ( a stable dosage for > or = 4 weeks prior to enrollment ) . Patients were stratified according to psoriasis body surface area ( BSA ) involvement ( > or = 3 % or < 3 % ) .  Alefacept ( 15 mg ) or placebo was administered intramuscularly once weekly for 12 weeks in combination with MTX , followed by 12 weeks of observation during which only MTX treatment was continued . The primary efficacy end point was the proportion of patients achieving a 20 % improvement in disease activity according to the American College of Rheumatology criteria ( an ACR20 response ) at week 24 . RESULTS One hundred eighty-five patients were r and omly assigned to receive alefacept plus MTX ( n = 123 ) or placebo plus MTX ( n = 62 ) . At week 24 , 54 % of patients in the alefacept plus MTX group achieved an ACR20 response , compared with 23 % of patients in the placebo plus MTX group ( P < 0.001 ) . Mean reductions in tender and swollen joint counts in patients receiving alefacept plus MTX were -8.0 and -6.3 , respectively . In patients with psoriasis involving > or = 3 % BSA ( n = 87 ) , a 50 % reduction from the baseline Psoriasis Area Severity Index at week 14 was achieved by 53 % of patients receiving alefacept plus MTX compared with 17 % of those receiving placebo plus MTX ( P < 0.001 ) . Most adverse events were mild to moderate in severity . In the alefacept plus MTX group , the incidence of serious adverse events was low ( 1.6 % ) , and no opportunistic infections or malignancies were reported . CONCLUSION Alefacept in combination with MTX may be an effective and safe treatment for OBJECTIVE Current treatment options for psoriatic arthritis ( PsA ) are limited . Leflunomide , an oral pyrimidine synthesis inhibitor , is highly effective in the treatment of rheumatoid arthritis , and small studies have suggested similar efficacy in PsA. We undertook this double-blind , r and omized , placebo-controlled trial to evaluate the efficacy and safety of leflunomide in patients with PsA and psoriasis . METHODS One hundred ninety patients with active PsA and psoriasis ( at least 3 % skin involvement ) were r and omized to receive leflunomide ( 100 mg/day loading dose for 3 days followed by 20 mg/day orally ) or placebo for 24 weeks . The primary efficacy end point was the proportion of patients classified as responders by the Psoriatic Arthritis Response Criteria ( PsARC ) . Additional 
    Output:
    
Differences existed in assessment of treatment effectiveness between crowd source d data and those published in the literature .
With improvements in the collection of crowd source d data , crowdsourcing can be a valuable tool for collecting patient data in real-world setting s for psoriasis and