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I am not surprised at the relative high incidence of GI side-effects, particularly when the Methotrexate dose exceeds 15mg/week. I have seen rheumatologists indiscriminately go for higher doses of Methotrexate right from the beginning. Studies on the use of Methotrexate in combination with an TNF-alpha inhibitor such as Adalimumab showed good efficacy with doses less than 15mg/week.