Evaluating the Effect of Digoxin and Ursodeoxycholic Acid in Patients With Rheumatoid Arthritis

Inclusion Criteria:

• Diagnosed with rheumatoid arthritis according to the ACR/EULAR 2010 criteria.
• Having active rheumatoid arthritis disease activity (the 28-joint disease activityscore [DAS28] according to the CRP formula > 2.6).
• Aged between 18 and 80 years.
• With clear consciousness and able to cooperate with this study.
• Personal willingness and ability to comply with the study follow-up schedule and otherrequirements of the study protocol.
• Both male and female will be included
• All patients receiving non-biological drugs will be also included.
• Sign an informed consent for the clinical study.

Exclusion Criteria:

• Pregnant or planning to be pregnant and breast-feeding women
• Patients suffering from any chronic diseases
• Patients with other autoimmune diseases, such as systemic lupus erythematosus,Sjogren's syndrome and mixed connective tissue disease.
• Patients who have a diagnosis of any other inflammatory arthritis (e.g., psoriaticarthritis or ankylosing spondylitis).
• Patients with a history of, or suspected, demyelinating disease of the central nervoussystem (e.g. multiple sclerosis or optic neuritis).
• Patients with a current or recent history of severe, progressive, and/or uncontrolledrenal, hepatic, hematological, gastrointestinal, endocrine, pulmonary, cardiac,neurological, or cerebral disease.
• Patients treated with biological therapy such as TNF-α or IL-1β antagonists.
• Patients with infectious or inflammatory diseases, endocrine disorders, any past orcurrent psychiatric or neurological diseases.
• Patients with cardiovascular diseases such as arrhythmias and acute myocardialinfarction.
• Patients with electrolyte disturbances (such as hypokalemia, hypomagnesemia, andhypercalcemia) could potentially elevate the risk of digoxin toxicity.
• Patients with clinically significant hepatic and renal dysfunction or impairment.
• Alcohol abuse
• Patients with evidence of viral (HBV or HCV), autoimmune hepatitis, and decompensatedliver disease.
• Patients with cancer currently diagnosed or in medical history, if no recovery wasachieved.
• Patients who are allergic to digoxin or Ursodeoxycholic acid (UDCA)
• Patients who are unconscious and unable to complete the study.
• Patients with acute inflammation of the gall bladder or the biliary tract, frequentepisodes of biliary colic, and impaired contractility of the gall bladder, will beexcluded.
• Patients with cholestasis, primary biliary cirrhosis, or biliary obstruction will alsobe excluded.
• Patients who have received an organ transplant.