***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 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 Hyaluronic acid is a natural component of cartilage and is considered not only as a lubricant in joints but also as playing a physiological role in the trophic status of cartilage . Hyalectin , a selected fraction of hyaluronic acid extracted from cocks ' combs , has exhibited efficacy in animal models of osteoarthritis . To assess the efficacy and tolerability of intra-articular injections of hyalectin , we conducted a prospect i ve , r and omized , placebo-controlled trial of 1 years ' duration in 110 patients with painful hydarthrodial osteoarthritis of the knee . At entry and once a week for 3 weeks , aspiration of the knee effusion and intra-articular injections of either hyalectin 20 mg ( H ) or its vehicle ( C ) were performed . The vehicle acted as the control treatment . Four weeks after the last injection , the improvement was greater in the H group compared with the C group ( pain : -35.5 + /- 26.4 mm vs -25.8 + /- 21.4 , P = 0.03 , Lequesne 's functional index : -3.8 + /- 4.3 vs -2.3 + /- 3.3 , P = 0.03 ) . During the 1 year follow-up , the need to perform supplementary local therapies ( joint fluid aspiration because of painful hydarthrodial episodes and /or local corticosteroid injections  ) was more frequent in group C ( 44 % vs 30 % , P = 0.03 ) . Moreover , at the final visit , the physician 's overall assessment of efficacy was in favor of H ( 77 % vs 54 % , P = 0.01 ) and the improvement in the functional index was greater in group H ( -4.4 + /- 5.1 vs -2.7 + /- 4.1 , P = 0.05 ) . This study suggests that intra-articular injections of hyalectin may ( 1 ) improve clinical condition and ( 2 ) have a long-term beneficial effect in patients with 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 OBJECTIVE To evaluate the efficacy of joint lavage and intraarticular steroid injection , alone and in combination , in the treatment of patients with symptomatic knee osteoarthritis ( OA ) . METHODS Ninety-eight patients with painful tibiofemoral OA were enrolled in a prospect i ve , r and omized , controlled , 2 x 2 factorial- design trial of 6 months ' duration . The 4 treatment groups consisted of 1 ) intraarticular placebo ( 1.5 ml of 0.9 % normal saline ) , 2 ) intraarticular corticosteroids ( 3.75 mg of cortivazol in 1.5 ml ) , 3 ) joint lavage and intraarticular placebo , and 4 ) joint lavage and intraarticular corticosteroid . Outcome measures evaluated at baseline , week 1 , week 4 , week 12 , and week 24 included severity of pain ( 100-mm visual analog scale [ VAS ] ) , global status ( 100-mm VAS ) , and Lequesne 's functional index . RESULTS No interaction between steroid injection and joint lavage was demonstrated . Patients who had undergone joint lavage had significantly improved pain VAS scores at week 24 ( P = 0.020 ) . In contrast , corticosteroid injection had no long-term effect ( P = 0.313 ) ; corticosteroid injection was associated with a decrease in pain only at week 1 ( P = 0.003 ) and week 4 ( P = 0.020 ) . After week 4 , Lequesne 's functional index was not significantly improved regardless of the assigned treatment . CONCLUSION Compared with placebo , both treatments significantly relieved pain but did not improve functional impairment . The effects of the 2 treatments were additive . Cortivazol provided short-term relief of pain ( up to week 4 ) . The effects of joint lavage persisted up to week 24 OBJECTIVE To evaluate the safety and efficacy of long-term intraarticular ( IA ) steroid injections for  knee pain related to osteoarthritis ( OA ) . METHODS In a r and omized , double-blind trial , 68 patients with OA of the knee received IA injections of triamcinolone acetonide 40 mg ( 34 patients ) or saline ( 34 patients ) into the study knee every 3 months for up to 2 years . The primary outcome variable was radiologic progression of joint space narrowing of the injected knee after 2 years . Measurements of minimum joint space width were performed by an automated computerized method on st and ardized fluoroscopically guided radiographs taken with the patient st and ing and with the knee in a semiflexed position . The clinical efficacy measure of primary interest was the pain subscale from the Western Ontario and McMaster Universities OA Index ( WOMAC ) . Efficacy measures of secondary interest were the total score on the WOMAC , physician 's global assessment , patient 's global assessment , patient 's assessment of pain , range of motion ( ROM ) of the affected knee , and 50-foot walking time . Clinical symptoms were assessed just before each injection . RESULTS At the 1-year and 2-year followup evaluations , no difference was noted between the two treatment groups with respect to loss of joint space over time . The steroid-injected knees showed a trend toward greater symptom improvement , especially at 1 year , for the WOMAC pain subscale , night pain , and ROM values ( P = 0.05 ) compared with the saline-injected knees . Using area under the curve analyses , knee pain and stiffness were significantly improved throughout the 2-year study by repeated injections of triamcinolone acetonide , but not saline ( P < 0.05 ) . CONCLUSION Our findings support the long-term safety of IA steroid 
    Output:
    
We concluded that intra-articular corticosteroids reduce knee pain for at least 1 week and that intra-articular corticosteroid injection is a short-term treatment of a chronic problem