***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 assess the efficacy of a single intra-articular injection of triamcinolone hexacetonide ( THA ) in knee osteoarthritis ( OA ) and examine factors which may relate to treatment efficacy . METHODS --Eighty four patients with clinical and radiographic evidence of knee OA were recruited and r and omly allocated to receive either THA ( 20 mg in 1 ml ) or placebo ( 0.9 % normal saline , 1 ml ) . Follow up assessment s evaluated the following outcome variables : patient opinion of overall change in the treated knee , visual analogue pain score ( VAS ) , distance walked in one minute ( WD ) , and Health Assessment Question naire modified for lower limb function ( HAQ ) . RESULTS --Seventy eight percent of THA and 49 % of placebo treated patients reported overall improvement at week 1 ( p < 0.05 ) . At week 6 , improvement was reported in 57 % and 55 % of patient groups , respectively . VAS improved in both groups at week 1 ( THA , p < 0.001 ; placebo , p < 0.05 ) and week 6 ( both p < 0.01 ) . Improvement in VAS was significantly greater among THA treated patients at week 1 only ( p < 0.01 ) . Subgroup analysis of THA treated patients revealed greater improvement in VAS among patients with clinical evidence of an effusion ( p < 0.05 ) , and those who had synovial fluid successfully aspirated at the time of injection ( p < 0.01 ) . WD improved in THA treated patients at week 1 ( p < 0.001 ) , and in both groups at week 6 ( THA , p < 0.001 ; placebo , p < 0.01 ) . Improvements in HAQ were seen in THA patients only at weeks 1 and 6 ( p < 0.05 ) . Regression analysis did not identify any additional clinical , radiographic , or synovial fluid characteristics which influenced the response . CONCLUSIONS --THA provided short term pain relief in knee OA . Increased benefit was associated with both clinical evidence of joint effusion and successful aspiration of synovial fluid at the time of injection 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 OBJECTIVES : To show whether intra-articular steroid injections are effective in osteoarthritis ; to determine factors that predict response ; and to determine whether injection has a beneficial effect on muscle strength . METHODS : Double blind , placebo controlled , crossover study in 59 patients with symptomatic osteoarthritis of the knee . Outcome measure- Primary outcome measure : change in visual analogue score for pain at three weeks . Predictors of response analysed using logistic regression with a 15 % decrease in pain score at three weeks defining response . RESULTS : Intra-articular methyl prednisolone acetate produced a significant reduction in visual analogue pain score at three weeks compared to both baseline ( median change -2.0 mm , interquartile range -16.25 to 4.0 ) and placebo ( median 0.0 mm , interquartile range -9.0 to 6.25 ) . No clinical predictors of response could be identified . Muscle strength was not significantly improved in the short term by intra-articular injection . CONCLUSIONS : Intra-articular corticosteroids are effective for short term relief of pain in osteoarthritis but predicting responders is not possible . There may be a place for their more widespread use 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 ) BACKGROUND Osteoarthritis ( OA ) is the most common joint disease encountered throughout Europe . A task force for the EULAR St and ing Committee for Clinical Trials met in 1998 to determine the method ological and logistical approach required for the development of evidence based guidelines for treatment of knee OA . The guidelines were restricted to cover all currently available treatments for knee OA diagnosed either clinical ly and /or radiographically affecting any compartment of the knee . METHODS The first stage was the selection of treatment modalities to be considered . The second stage comprised a search of the electronic data bases Medline and Embase using a combination of subject headings and keywords . All European language publications in the form of systematic review s , meta-analyses , r and omised controlled trials , controlled trials , and observational studies were included . During stage three all the relevant studies were quality scored . The summary statistics for vali date d outcome measures , when available , were recorded and , where practical , the numbers needed to treat and the effect size for each treatment were calculated . In the fourth stage key clinical propositions were determined by expert consensus employing a Delphi approach . The final stage ranked these propositions according to the available evidence . A second set of propositions relating to a future research agenda was determined by expert consensus using a Delphi approach . RESULTS Over 2400 English language publications and 400 non-English language publications were identified . Seven hundred and forty four studies presented outcome data of the effects of specific treatments on knee OA . Quantitative analysis of treatment effect was possible in only 61 studies . Recommendations for the management of knee OA based on currently available data and expert opinion are presented . Proposals for a future research agenda are highlighted . CONCLUSIONS These are the first clinical guidelines on knee OA to combine an evidence based approach and a consensus approach across a wide range of treatment modalities . It is apparent that certain clinical propositions are supported by substantial research based evidence , while others are not . There is thus an urgent need for future well design ed trials to consider key clinical questions 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 OBJECTIVE The study was part of a r and omized open-label clinical trial design ed to evaluate the effects of intra-articular injections of hyaluronan ( Hyalgan ) ( HY ) in osteoarthritis ( OA ) of the human knee . Data were compared with those obtained after treatment with methylprednisolone acetate ( Depomedrol ) ( MP ) . METHODS Synovial membranes from patients with OA of the knee , primary or secondary to a traumatic event and classified according to the American College of Rheumatology criteria , were examined by arthroscopy and by light and electron microscopy before and 6 months after local injection of HY ( 2 ml of 500 - 730 000 MW hyaluronan , 10 mg/ml in saline , one injection per week for 5 weeks ) or MP ( 1 ml of methylprednisolone acetate , 40 mg/ml , one injection per week for 3 weeks ) . RESULTS Arthroscopy revealed a significant decrease in inflammatory score after both treatments . Histology showed that HY treatment was effective ( P < or = 0.05 ) in reducing the number and aggregation of lining synoviocytes , as well as the number and calibre of the vessels . MP treatment significantly reduced the number of mast cells in primary OA . Both treatments tended to decrease the number of hypertrophic and to increase the number of fibroblast-like lining cells , to decrease the numbers of macrophages , lymphocytes , mast cells and adipocytes , and to decrease oedema , especially in primary OA , and to increase the number of fibroblasts and the amount of collagen . These phenomena were evident throughout the thickness of the synovial tissue . CONCLUSION At least in the medium term , both HY and MP modified a number of structural variables of the synovial membrane of the osteoarthritic human knee towards the appearance of that of normal synovium . The effect was more evident in primary OA than in OA secondary to a traumatic event . This is the first evidence that local hyaluronan injections modify the structural organization of the human knee synovium in OA Osteoarthritic knee pain affects patient mobility . Relief of knee pain in osteoarthritis has been reported to increase loading of the knee during gait , but it is unknown whether such pain relief enhances knee loading during more dem and ing activities such as stair-stepping . The gait of 19 patients and stair-stepping of 14 patients with painful medial compartment osteoarthritis of the knee was assessed before and after pain-relieving intraarticular injection of the knee and compared with those of 21 healthy control subjects . There were significant increases in gait velocity , cadence , maximum external knee adduction moment ( indicating increased loading in the medial compartment of the knee ) , and maximum external hip adduction and ankle abduction moments immediately after the injection . With the exception of velocity and ankle abduction moment , these variables were returned to levels that were not statistically different from those of the control subjects . However , no significant differences were found during stair-stepping in the external adduction-abduction moments about the knee , hip , or ankle after injection . Furthermore , the postinjection magnitudes of these variables during stair-stepping were significantly less than those of the controls . Therefore , although the relief of knee pain is sufficient to enhance gait function in osteoarthritis of the knee , it is insufficient to enhance stair-stepping function The goal of this study was to assess the safety and efficacy of hyaluronan ( HA ) with/without corticosteroid in patients with knee osteoarthritis ( OA 
    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 .