Hello Dear, Its true that adalimumab have few severe side effects but those r justified because rheumatoid arthritis is an auto immune disorder that means our own immunity is behaving abnormally, and adalimumab is somewhere reducing our own immunity and thus increase the risk of infection but that is the treatment of auto immune disorder. It is essential in this patient because at the age of 53 she has undergone bilateral hip and knee replacement and still having pain and other symptoms that means her disease is progressing, so we need to give her something which not only reduces her pain but also reduces the progression of disease. If we talk about its success rates then yes it is effective in reducing symptoms and progression of RA. Regarding other treatment options there are many like analgesics NSAID's , DMARD's like methotrexate and hydrochlroquine but for sure your rheumatologist must have tried these because adalimumab is mostly started when these fails to give relief. There are also drugs like adalimumab i.e. etanercept,infliximab but adalimumab is more effective and easily tolerable. I would suggest you to only take these medications under guidance of rheumatologist because side effects have to be monitored and treated on time. Actually it's very big topic to discuss about,not possible to write everything. You can research more by going through article on " safety and effectiveness of adalimumab for treatment of RA" Hope it helps.