Effect of an intravenously administered bile acid (chenodeoxycholic acid) on rheumatoid arthritis

On the basis of the earlier observations of an ameliorating effect of jaundice on rheumatoid arthritis, the purpose of the present study was to confirm the influence of bile acids on rheumatoid arthritis. Ten patients were treated with intravenous infusions of chenodeoxycholic acid in single doses of 1-2 g, given over 5-8 hours on 1-4 consecutive days. The concentration of serum bile acids during the infusions were determined. The effect of the treatment was evaluated by means of the subjective experience of the patients, together with the ESR and Lansbury's clinical index. In 6 of the patients, pain relief was obtained for periods of up to 14 days after the last infusion, whereas the symptoms in the remaining 4 patients were unchanged. Where the ESR and the clinical index were concerned, it was characteristic that the course rose and fell, most often with an increase in initial values followed by a cecrease to below the pre-treatment level. In relation to the bile acid infusions, a brief rise, in most cases marked, was observed in the rheuma factors (Waaler-Rose). The serum bile acid concentrations registered during the infusions varied widely. However, no relation was observed between the concentrations and the effect. In all patients, phlebitis occurred in conjunction with each of the infusions. Transient, slight signs of liver injury were recorded in 3 patients, and, in 1 further patient, these signs were more pronounced and accompanied by fever together with deterioration of the joint condition. In all cases, the symptoms had disappeared within 1 week. It is concluded that a certain effect of the bile acid infusions on the clinical condition of rheumatoid arthritis and its related parameters was established. However, the effect was both temporary and inadequate, and especially because of the inevitable occurrence of phlebitis treatment cannot be recommended in tis present form.