human
***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 make a longitudinal study of antibodies to Klebsiella pneumoniae in patients with ankylosing spondylitis ( AS ) and to assess treatment effects . As a comparison we measured antibodies of 2 other gut associated bacteria , Escherichia coli and Proteus mirabilis . METHODS In a double blind study in 84 Finnish out patients with AS before and after 26 weeks ' treatment with sulfasalazine or placebo  we measured serum antibodies to Klebsiella pneumoniae , E. coli and Proteus mirabilis with ELISA : Serum sample s of 100 healthy blood donors served as controls . RESULTS The levels of IgA class antibodies to all 3 bacteria were statistically significantly higher in the sera of the patients compared to the controls . During sulfasalazine treatment significant decreases were observed in concentrations of the IgA class antibodies to Klebsiella and E. coli whereas only a slight decrease was observed in the concentrations of IgA antibodies to Proteus mirabilis . There were no correlations between the clinical and laboratory results observed with sulfasalazine and decrease in concentrations of IgA class antibodies . CONCLUSION Our results agree with the role of gut associated lymphoid tissue in the pathogenesis of AS , but do not totally exclude Klebsiella pneumoniae as a specific agent contributing to the development of AS In recent years sulphasalazine has gained acceptance as an effective agent for the treatment of rheumatoid arthritis . Ankylosing spondylitis is a disease where remission inducing drugs so far have been lacking . In this double blind trial sulphasalazine was compared with placebo in 37 patients with ankylosing spondylitis . Evaluation after three months ' treatment showed reduction of inflammatory activity and improvement of clinical variables . The side effects were mild . The results suggest that sulphasalazine is a potentially effective and safe drug in the treatment of ankylosing spondylitis OBJECTIVE To compare the efficacy of sulfasalazine ( SSZ ) with its two moieties , 5-aminosalicylic acid ( ASA ) and sulfapyridine ( SP ) , in patients with active ankylosing spondylitis ( AS ) . METHODS A 26-week r and omized , observer-blinded , 2-center , controlled study of treatment with either SSZ , ASA , or SP was conducted in 90 patients with active AS . Patients were evaluated at baseline and at monthly intervals , using several clinical and laboratory measures of disease activity . A global assessment of treatment efficacy was made by both patients and observers at the end of the study period . RESULTS There were no significant changes in any of the parameters of disease activity in the ASA treatment group . Levels of serum IgG , IgA , and IgM fell significantly during treatment with SP , but none of the other changes reached statistical significance . Plasma viscosity and IgG and IgA levels fell significantly during treatment with SSZ , as did nocturnal spinal pain and overall spinal pain . Patients and observers reported a favorable outcome after treatment with SSZ or SP significantly more often than with ASA treatment . CONCLUSION SP appears to be the active moiety in AS , although there was a trend suggesting a better outcome in the SSZ group compared with the SP group , perhaps suggesting the importance of a common sulfonamide structure for efficacy OBJECTIVES To assess the effect of sulfasalazine ( SSZ ) on inflammatory back pain ( IBP ) due to active undifferentiated spondyloarthritis ( uSpA ) or ankylosing spondylitis in patients with symptom duration < 5 years . METHODS Patients with IBP and a Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) > 3 from 12 centres were r and omly assigned to 24 weeks ' treatment with SSZ 2 g/day or placebo . The primary outcome variable was the change in BASDAI over 6 months . Secondary outcomes included measures of spinal pain , physical function and inflammation . RESULTS 230 patients ( 50 % men , age range 18 - 64 years , 67 % human leucocyte antigen B27 positive ) were treated with either SSZ 2x1 g/day or placebo for 6 months . Enthesitis was found in 50 % , and peripheral arthritis in 47 % of the patients . The mean ( SD ) BASDAI dropped markedly in both groups : by 3.7 ( 2.7 ) and 3.8 ( 2.4 ) , respectively , as did most secondary outcome measures . No noticeable difference in treatment was observed between groups . Patients with IBP and no peripheral arthritis had significantly ( p = 0.03 ) more benefit with SSZ ( BASDAI 5.1 ( 1.3 ) to 2.8 ( 2.3 ) ) than with placebo ( 5.2 ( 1.6 ) to 3.8 ( 2.4 ) ) . Spinal pain ( p = 0.03 ) and morning stiffness ( p = 0.05 ) improved with SSZ in these patients , but other secondary outcomes were not markedly different . CONCLUSION SSZ was no better than placebo for the treatment of the signs and symptoms of uSpA ; however , SSZ was more effective than placebo in the subgroup of patients with IBP and no peripheral arthritis 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 of salazosulfapyridine ( SI ) has been recently reported in the course of peripheral arthritis in ankylosing spondylarthritis ( SPA ) , but is action on the axial forms of the disease was not known . We have therefore conducted a therapeutic trial in 60 patients suffering from SPA , without peripheral involvement clinical sign evoking an enterocolopathy . This double-blind study compared the activity of SI at a dose of 2 g/day with a placebo , for 6 months . Thirteen patients had to discontinue the treatment : 6 in the placebo group ( inefficacy : 3 cases , anemia : 1 case , epigastric pain : 1 case , rash : 1 case ) and 7 cases in the SI group ( inefficacy : 2 cases , nauseous : 3 cases , abdominal pain : 1 case , moderate elevation of transaminases : 1 case ) . These 13 patients were kept for the global analysis and considered as therapeutic failures . The treatment was considered effective in 15 out of 30 patients of group SI and in 30 patients on placebo ( p less than 0.02 ) . In addition , in group SI , a statistically significant decrease of the daily dose of non-steroid anti-inflammatory drugs  was observed ( -6.5 + /- 7.2 versus -2.4 + /- 6.4 in the placebo group , p less than 0.05 ) ; also was observed a decrease of the functional index ( -5.9 + /- 6.6 versus -1.9 + /- 5.7 in the group placebo , p less than 0.05 ) and of the serum level of immunoglobulin G ( -1.8 + /- 3.6 g/l versus + 0.8 + /- 2.9 in the placebo group , p less than 0.025 ) . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND There are few effective treatments for ankylosing spondylitis , which causes substantial morbidity . Because of the central role of tumor necrosis factor alpha in the spondyloarthritides , we performed a r and omized , double-blind , placebo-controlled trial of etanercept , a recombinant human tumor necrosis factor receptor (p75):Fc fusion protein , in patients with ankylosing spondylitis . METHODS Forty patients with active , inflammatory ankylosing spondylitis were r and omly assigned to receive twice-weekly subcutaneous injections of etanercept ( 25 mg ) or placebo for four months . The primary end point was a composite of improvements in measures of morning stiffness , spinal pain , functioning , the patient 's global assessment of disease activity , and joint swelling . Patients were allowed to continue taking nonsteroidal antiinflammatory drugs , oral corticosteriods ( < or = 10 mg per day ) , and disease-modifying antirheumatic drugs at stable doses during the trial . RESULTS Treatment with etanercept result ed in significant and sustained improvement . At four months , 80 percent of the patients in the etanercept group had a treatment response , as compared with 30 percent of those in the placebo group ( P=0.004 ) . Improvements over base-line values for various measures of disease activity , including morning stiffness , spinal pain , functioning , quality of life , enthesitis , chest expansion , erythrocyte sedimentation rate , and C-reactive protein , were significantly greater in the etanercept group . Longitudinal analysis showed that the treatment response was rapid and did not diminish over time . Etanercept was well tolerated , with no significant differences in rates of adverse events between the two groups . CONCLUSIONS Treatment with etanercept for four months result ed in rapid , significant , and sustained improvement in patients with ankylosing spondylitis UNLABELLED BACKGROUND Treatment options for patients with ankylosing spondylitis are few . We aim ed to assess the effectiveness of infliximab , an antibody to tumour necrosis factor (TNF)-alpha , in treatment of such patients . METHODS In this 12-week placebo-controlled multicentre study , we r and omly assigned 35 patients with active ankylosing spondylitis to intravenous infliximab ( 5 mg/kg ) and 35 to placebo at weeks 0 , 2 , and 6 . One patient in the infliximab group was withdrawn from the study . Our primary outcome was regression of disease activity of at least 50 % . To assess response , we used vali date d clinical criteria from the ankylosing spondylitis assessment working group , including disease activity ( BASDAI ) , functional indices ( BASFI ) , metrology ( BASMI ) , and quality of life ( short form 36 ) . Analyses were done by intention to treat . FINDINGS 18 ( 53 % ) of 34 patients on infliximab had a regression of disease activity at week 12 of at least 50 % compared with three ( 9 % ) of 35 on placebo ( difference 44 % [ 95 % CI 23 - 61 ] , p<0.0001 ) . Function and quality of life also improved significantly on infliximab but not on placebo ( p<0.0001 and p<0.0001 , respectively ) . Treatment with infliximab was generally well tolerated , but three patients had to stop treatment because of systemic tuberculosis , allergic granulomatosis of the lung , or mild leucopenia . INTERPRETATION Our results show that treatment with infliximab is effective in patients with active ankylosing spondylitis . Since there are some potentially serious adverse effects , we recommend that this treatment mainly be used in co-operation with rheumatological centres Summary In a 12-month double-blind placebo-controlled trial , the effect of sulphasalazine was studied in 40 patients with ankylosing spondylitis . The treatment group showed significant improvement in pain , stiffness , sleep disturbance ( p<0.05 ) , finger/floor distance , erythrocyte sedimentation rate , C-reactive protein , orosomucoid and IgA levels ( p<0.01 ) . There was improvement in sleep disturbance ( p<0.05 ) , finger/floor distance and erythrocyte sedimentation rate ( p<0.01 ) in the placebo group . Sulphasalazine did not retard radiological progression as measured either by plain X-ray or computerised tomographic scans . Multiple analysis of variance did not show a significant difference in disease activity indicators between the 2 groups OBJECTIVE To determine whether sul 
    Output:
    
agent
There is not enough evidence to support any benefit of sulfasalazine in reducing pain , disease activity , radiographic progression , or improving physical function and spinal mobility in the treatment of AS .
A statistically significant benefit in reducing the erythrocyte sedimentation rate and easing spinal stiffness was mentioned in the previous version .
More withdrawals because of side effects occurred with sulfasalazine .
***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 make a longitudinal study of antibodies to Klebsiella pneumoniae in patients with ankylosing spondylitis ( AS ) and to assess treatment effects . As a comparison we measured antibodies of 2 other gut associated bacteria , Escherichia coli and Proteus mirabilis . METHODS In a double blind study in 84 Finnish out patients with AS before and after 26 weeks ' treatment with sulfasalazine or placebo  we measured serum antibodies to Klebsiella pneumoniae , E. coli and Proteus mirabilis with ELISA : Serum sample s of 100 healthy blood donors served as controls . RESULTS The levels of IgA class antibodies to all 3 bacteria were statistically significantly higher in the sera of the patients compared to the controls . During sulfasalazine treatment significant decreases were observed in concentrations of the IgA class antibodies to Klebsiella and E. coli whereas only a slight decrease was observed in the concentrations of IgA antibodies to Proteus mirabilis . There were no correlations between the clinical and laboratory results observed with sulfasalazine and decrease in concentrations of IgA class antibodies . CONCLUSION Our results agree with the role of gut associated lymphoid tissue in the pathogenesis of AS , but do not totally exclude Klebsiella pneumoniae as a specific agent contributing to the development of AS In recent years sulphasalazine has gained acceptance as an effective agent for the treatment of rheumatoid arthritis . Ankylosing spondylitis is a disease where remission inducing drugs so far have been lacking . In this double blind trial sulphasalazine was compared with placebo in 37 patients with ankylosing spondylitis . Evaluation after three months ' treatment showed reduction of inflammatory activity and improvement of clinical variables . The side effects were mild . The results suggest that sulphasalazine is a potentially effective and safe drug in the treatment of ankylosing spondylitis OBJECTIVE To compare the efficacy of sulfasalazine ( SSZ ) with its two moieties , 5-aminosalicylic acid ( ASA ) and sulfapyridine ( SP ) , in patients with active ankylosing spondylitis ( AS ) . METHODS A 26-week r and omized , observer-blinded , 2-center , controlled study of treatment with either SSZ , ASA , or SP was conducted in 90 patients with active AS . Patients were evaluated at baseline and at monthly intervals , using several clinical and laboratory measures of disease activity . A global assessment of treatment efficacy was made by both patients and observers at the end of the study period . RESULTS There were no significant changes in any of the parameters of disease activity in the ASA treatment group . Levels of serum IgG , IgA , and IgM fell significantly during treatment with SP , but none of the other changes reached statistical significance . Plasma viscosity and IgG and IgA levels fell significantly during treatment with SSZ , as did nocturnal spinal pain and overall spinal pain . Patients and observers reported a favorable outcome after treatment with SSZ or SP significantly more often than with ASA treatment . CONCLUSION SP appears to be the active moiety in AS , although there was a trend suggesting a better outcome in the SSZ group compared with the SP group , perhaps suggesting the importance of a common sulfonamide structure for efficacy OBJECTIVES To assess the effect of sulfasalazine ( SSZ ) on inflammatory back pain ( IBP ) due to active undifferentiated spondyloarthritis ( uSpA ) or ankylosing spondylitis in patients with symptom duration < 5 years . METHODS Patients with IBP and a Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) > 3 from 12 centres were r and omly assigned to 24 weeks ' treatment with SSZ 2 g/day or placebo . The primary outcome variable was the change in BASDAI over 6 months . Secondary outcomes included measures of spinal pain , physical function and inflammation . RESULTS 230 patients ( 50 % men , age range 18 - 64 years , 67 % human leucocyte antigen B27 positive ) were treated with either SSZ 2x1 g/day or placebo for 6 months . Enthesitis was found in 50 % , and peripheral arthritis in 47 % of the patients . The mean ( SD ) BASDAI dropped markedly in both groups : by 3.7 ( 2.7 ) and 3.8 ( 2.4 ) , respectively , as did most secondary outcome measures . No noticeable difference in treatment was observed between groups . Patients with IBP and no peripheral arthritis had significantly ( p = 0.03 ) more benefit with SSZ ( BASDAI 5.1 ( 1.3 ) to 2.8 ( 2.3 ) ) than with placebo ( 5.2 ( 1.6 ) to 3.8 ( 2.4 ) ) . Spinal pain ( p = 0.03 ) and morning stiffness ( p = 0.05 ) improved with SSZ in these patients , but other secondary outcomes were not markedly different . CONCLUSION SSZ was no better than placebo for the treatment of the signs and symptoms of uSpA ; however , SSZ was more effective than placebo in the subgroup of patients with IBP and no peripheral arthritis 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 of salazosulfapyridine ( SI ) has been recently reported in the course of peripheral arthritis in ankylosing spondylarthritis ( SPA ) , but is action on the axial forms of the disease was not known . We have therefore conducted a therapeutic trial in 60 patients suffering from SPA , without peripheral involvement clinical sign evoking an enterocolopathy . This double-blind study compared the activity of SI at a dose of 2 g/day with a placebo , for 6 months . Thirteen patients had to discontinue the treatment : 6 in the placebo group ( inefficacy : 3 cases , anemia : 1 case , epigastric pain : 1 case , rash : 1 case ) and 7 cases in the SI group ( inefficacy : 2 cases , nauseous : 3 cases , abdominal pain : 1 case , moderate elevation of transaminases : 1 case ) . These 13 patients were kept for the global analysis and considered as therapeutic failures . The treatment was considered effective in 15 out of 30 patients of group SI and in 30 patients on placebo ( p less than 0.02 ) . In addition , in group SI , a statistically significant decrease of the daily dose of non-steroid anti-inflammatory drugs  was observed ( -6.5 + /- 7.2 versus -2.4 + /- 6.4 in the placebo group , p less than 0.05 ) ; also was observed a decrease of the functional index ( -5.9 + /- 6.6 versus -1.9 + /- 5.7 in the group placebo , p less than 0.05 ) and of the serum level of immunoglobulin G ( -1.8 + /- 3.6 g/l versus + 0.8 + /- 2.9 in the placebo group , p less than 0.025 ) . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND There are few effective treatments for ankylosing spondylitis , which causes substantial morbidity . Because of the central role of tumor necrosis factor alpha in the spondyloarthritides , we performed a r and omized , double-blind , placebo-controlled trial of etanercept , a recombinant human tumor necrosis factor receptor (p75):Fc fusion protein , in patients with ankylosing spondylitis . METHODS Forty patients with active , inflammatory ankylosing spondylitis were r and omly assigned to receive twice-weekly subcutaneous injections of etanercept ( 25 mg ) or placebo for four months . The primary end point was a composite of improvements in measures of morning stiffness , spinal pain , functioning , the patient 's global assessment of disease activity , and joint swelling . Patients were allowed to continue taking nonsteroidal antiinflammatory drugs , oral corticosteriods ( < or = 10 mg per day ) , and disease-modifying antirheumatic drugs at stable doses during the trial . RESULTS Treatment with etanercept result ed in significant and sustained improvement . At four months , 80 percent of the patients in the etanercept group had a treatment response , as compared with 30 percent of those in the placebo group ( P=0.004 ) . Improvements over base-line values for various measures of disease activity , including morning stiffness , spinal pain , functioning , quality of life , enthesitis , chest expansion , erythrocyte sedimentation rate , and C-reactive protein , were significantly greater in the etanercept group . Longitudinal analysis showed that the treatment response was rapid and did not diminish over time . Etanercept was well tolerated , with no significant differences in rates of adverse events between the two groups . CONCLUSIONS Treatment with etanercept for four months result ed in rapid , significant , and sustained improvement in patients with ankylosing spondylitis UNLABELLED BACKGROUND Treatment options for patients with ankylosing spondylitis are few . We aim ed to assess the effectiveness of infliximab , an antibody to tumour necrosis factor (TNF)-alpha , in treatment of such patients . METHODS In this 12-week placebo-controlled multicentre study , we r and omly assigned 35 patients with active ankylosing spondylitis to intravenous infliximab ( 5 mg/kg ) and 35 to placebo at weeks 0 , 2 , and 6 . One patient in the infliximab group was withdrawn from the study . Our primary outcome was regression of disease activity of at least 50 % . To assess response , we used vali date d clinical criteria from the ankylosing spondylitis assessment working group , including disease activity ( BASDAI ) , functional indices ( BASFI ) , metrology ( BASMI ) , and quality of life ( short form 36 ) . Analyses were done by intention to treat . FINDINGS 18 ( 53 % ) of 34 patients on infliximab had a regression of disease activity at week 12 of at least 50 % compared with three ( 9 % ) of 35 on placebo ( difference 44 % [ 95 % CI 23 - 61 ] , p<0.0001 ) . Function and quality of life also improved significantly on infliximab but not on placebo ( p<0.0001 and p<0.0001 , respectively ) . Treatment with infliximab was generally well tolerated , but three patients had to stop treatment because of systemic tuberculosis , allergic granulomatosis of the lung , or mild leucopenia . INTERPRETATION Our results show that treatment with infliximab is effective in patients with active ankylosing spondylitis . Since there are some potentially serious adverse effects , we recommend that this treatment mainly be used in co-operation with rheumatological centres Summary In a 12-month double-blind placebo-controlled trial , the effect of sulphasalazine was studied in 40 patients with ankylosing spondylitis . The treatment group showed significant improvement in pain , stiffness , sleep disturbance ( p<0.05 ) , finger/floor distance , erythrocyte sedimentation rate , C-reactive protein , orosomucoid and IgA levels ( p<0.01 ) . There was improvement in sleep disturbance ( p<0.05 ) , finger/floor distance and erythrocyte sedimentation rate ( p<0.01 ) in the placebo group . Sulphasalazine did not retard radiological progression as measured either by plain X-ray or computerised tomographic scans . Multiple analysis of variance did not show a significant difference in disease activity indicators between the 2 groups OBJECTIVE To determine whether sul 
    Output:
    