***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 evaluate the effects of a mindfulness-based group intervention , the Vitality Training Programme ( VTP ) , in adults with inflammatory rheumatic joint diseases . Methods In a r and omised controlled trial , the VTP — a 10-session mindfulness-based group intervention including a booster session after 6 months — was compared with a control group that received routine care plus a CD for voluntary use with mindfulness-based home exercises . The primary outcome was psychological distress measured by the General Health Question naire-20 . Self-efficacy ( pain and symptoms ) and emotion-focused coping ( emotional processing and expression ) were used as co- primary outcomes . Secondary outcomes included pain , fatigue , patient global disease activity , self-care ability and well-being . Effects were estimated by mixed models repeated measures post-intervention and at 12-month follow-up . Results Of 73 participants r and omised , 68 completed assessment s post-intervention and 67 at 12 months . Significant treatment effects in favour of the VTP group were found post-treatment and maintained at 12 months in psychological distress ( adjusted mean between-group difference −3.7 , 95 % CI −6.3 to −1.1 ) , self-efficacy pain ( 9.1 , 95 % CI 3.4 to 14.8 ) and symptoms ( 13.1 , 95 % CI 6.7 to 19.3 ) , emotional processing ( 0.3 , 95 % CI 0.02 to 0.5 ) , fatigue ( −1.1 , 95 % CI −1.8 to −0.4 ) , self-care ability ( 1.0 , 95 % CI 0.5 to 1.6 ) and overall well-being ( 0.6 , 95 % CI 0.1 to 1.2 ) . No significant group differences were found in emotional expression , pain or disease activity . Conclusion The VTP improved most primary and secondary outcomes compared with individual use of CD exercises . Improvements were maintained at 12 months , suggesting that the VTP is a beneficial complement to existing treatments for patients with inflammatory rheumatic joint diseases Objective : To investigate the efficacy of a Mediterranean diet ( MD ) versus an ordinary Western diet for suppression of disease activity in patients with rheumatoid arthritis ( RA ) . Methods : Patients with well controlled , although active RA of at least two years ’ duration , who were receiving stable pharmacological treatment , were invited to participate . All patients were r and omly allocated to the MD or the control diet ( CD ) . To achieve good compliance with prescribed diets all patients were for the first three weeks served the MD or the CD , respectively , for lunch and dinner at the outpatient clinic ’s canteen . Clinical examinations were performed at baseline , and again in the 3rd , 6th , and 12th week . A composite disease activity index ( DAS28 ) , a physical function index ( Health Assessment Question naire ( HAQ ) ) , a health survey of quality of life ( Short Form-36 ( SF-36 ) ) , and the daily consumption of non-steroidal anti-inflammatory drugs were used as primary efficacy variables . Results : From baseline to the end of the study the patients in the MD group ( n=26 ) showed a decrease in DAS28 of 0.56 ( p<0.001 ) , in HAQ of 0.15 ( p=0.020 ) , and in two dimensions of the SF-36 Health Survey : an increase in “ vitality ” of 11.3 ( p=0.018 ) and a decrease in “ compared with one year earlier ” of 0.6 ( p=0.016 ) . For the control patients ( n=25 ) no significant change was seen at the end of the study . This difference between the two treatment groups was notable only in the second half of the trial . Conclusion : The results indicate that patients with RA , by adjusting to a Mediterranean diet , did obtain a reduction in inflammatory activity , an increase in physical function , and improved vitality Forty-six female patients with rheumatoid arthritis or primary Sjögren 's syndrome participated in a prospect i ve , controlled study of psychodynamic , time-limited group therapy . The paper concentrates on the qualitative outcome evaluated according to the patients ' perceptions of what was appreciated as being most helpful in the group . Yalom 's ' curative factors Q-sort ' served as parameter of effect . Special attention will be given to the prevalence of alexithymia in rheumatic patients , and to the possibilities of ameliorating alexithymic features through group therapy 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 OBJECTIVE In rheumatoid arthritis , education programmes successfully impart knowledge but , notwithst and ing issues of empowerment , this knowledge has to be translated into behavioural change to have a chance of improving disease outcome . Arguably , behavioural change must also occur early if outcomes are to be improved . For these reasons , we planned a study of patient education in early disease , with radiological damage and quality of life as the main outcome variables . METHODS We performed a r and omized controlled trial in people with rheumatoid arthritis of < 5 yr duration . The main intervention was a 4 week education programme , each weekly session lasting 2 h. Assessment s were made at entry , at 4 weeks and at 12 months . The main outcome variables were the modified Larsen radiological score for the h and s and the SF-36 quality of life question naire . Secondary outcome variables were the Health Assessment Question naire ( HAQ ) , Ritchie Articular Index ( RAI ) , Patient Knowledge Question naire ( PKQ ) , Compliance Question naire ( CQ ) , plasma viscosity ( PV ) , pharmaceutical changes and consulting behaviour . RESULTS The patient numbers were 34 ( 10 male , 24 female ) for the control group and 43 ( 16 male , 27 female ) for the education group . The groups were matched for age ( 56.5 yr for control , 55 yr for education ) , disease duration ( 3.5 yr vs 3.0 yr ) and duration of second-line drug therapy ( 14 months vs 12 months ) . We found no significant difference between the groups for Larsen scores at 12 months , although scores for the education group were lower ( 39.5 vs 43.0 , P = 0.13 ) . The ' social functioning ' and ' general health perception ' subscales of the SF-36 showed a significant improvement in the education group , but no significant differences between groups were seen . No significant differences were found for the HAQ , RAI , PV and CQ , but the education group had more disease-specific knowledge than the control group at 12 months ( PKQ scores : 17 vs 21 , P = 0.0002 ) . No differences were found for out-patient visits and in-patient admissions , but the education group had slightly more changes in second-line drugs during the study ( 0.43 changes/person in the control group , 0.51 changes/person in the education group ) . CONCLUSIONS We found no significant difference between the groups in our primary outcome measures , but a trend in favour of the education group was found in radiological progression . Further studies of this kind , using larger patient numbers , are required since the difference may result from improved self-care , better compliance with joint protection strategies and , possibly , improved drug compliance OBJECTIVE Studies have suggested that the Arthritis Self-Management Program ( ASMP ) course is effective at reducing arthritis pain and health care costs  in volunteer participants . There have been no reports of trials of the ASMP in the context of primary care physicians ' practice s , where the potential for spreading the program may be greatest . We conducted a r and omized controlled trial of the ASMP course in a large primary care physician network . METHODS Patients with osteoarthritis , rheumatoid arthritis , or fibromyalgia were recruited for the study . Subjects in the intervention practice s received the 6 week course and those in the control practice s received only the ASMP book , without course .  Disability , pain , self-efficacy , mental health , and satisfaction were measured using vali date d instruments at baseline and at 4 months . RESULTS One hundred thirteen patients were recruited for the ASMP course  ( intervention ) and completed baseline and 4 month followup question naires . Eighty-four percent completed at least 4 of 6 classes . Seventy-four patients received the ASMP manual ( controls ) and completed both question naires . Patients in the intervention and control groups had similar baseline pain ( p = 0.94 ) , self-efficacy to control pain ( p = 0.90 ) , mental health ( p = 0.10 ) , and vitality scores ( p = 0.21 ) , but those in the intervention arm had slightly less disability ( p = 0.04 ) . At 4 months , there was no significant improvement from baseline in any endpoint and no difference between patients in the intervention and control groups ( all p > 0.2 ) . Patient satisfaction with arthritis care and outcomes was no different for intervention and 
    Output:
    
This review provides some evidence that physical activity and psychosocial interventions provide benefit in relation to self-reported fatigue  in adults with rheumatoid arthritis .
There is currently insufficient evidence of the effectiveness of other non-pharmacological interventions