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doi: 10.1080/15227950591008240

They also reported a more significant improvement of the arthritis score with combination treatment than with MTX alone

Combination protocols carry added complexity and risk

These effects may be more pronounced in patients with altered gastric anatomy Pancreatitis risk : Patients should be informed about symptoms of acute pancreatitis (severe abdominal pain, sometimes radiating to the back, with vomiting) and seek immediate medical attention if these occur Gallbladder disease : Increased risk of gallstones and gallbladder-related problems, particularly with substantial weight loss Dehydration and acute kidney injury : Reduced fluid intake combined with gastrointestinal side effects may increase risk of dehydration Nutritional concerns : The combination of reduced stomach capacity and appetite suppression may increase the risk of nutritional deficiencies, particularly protein, vitamin B12, iron, and calcium Hypoglycaemia risk : Especially in patients taking diabetes medications, careful monitoring and dose adjustment may be necessary Diabetic retinopathy : Patients with diabetes should have appropriate eye screening, as rapid improvement in glucose control may temporarily worsen retinopathy Medication absorption : GLP-1 receptor agonists may affect absorption of oral medications due to delayed gastric emptying Pregnancy and contraception : These medications are not recommended during pregnancy or breastfeeding