Acute or chronic renal failure (creatinine rise above 3 mg/dL during the last 48 hours or GFR les than 30 mL/min) Liver failure (LFT rise five times the upper limit or three time rise in symptomatic patients or Child Pugh C or D) Allergic reaction while injecting adalimimab with severe extravasation or anaphylactic reaction. Patient with mild disease Pregnancy or breastfeeding Patients with IL-6 below 7 pg/ml Patient with latent or active TB or any other active infection History of active pectic ulcer Receiving drugs effective on interleukin or TNF alpha History of malignancy Patient with heart failure

Acute or chronic renal failure (creatinine rise above 3 mg/dL during the last 48 hours or GFR les than 30 mL/min) Liver failure (LFT rise five times the upper limit or three time rise in symptomatic patients or Child Pugh C or D) Allergic reaction while injecting adalimimab with severe extravasation or anaphylactic reaction. Patient with mild disease Pregnancy or breastfeeding Patients with IL-6 below 7 pg/ml Patient with latent or active TB or any other active infection History of active pectic ulcer Receiving drugs effective on interleukin or TNF alpha History of malignancy Patient with heart failure