Would you consider adding dupilumab to adalimumab (or other monoclonal antibodies) in a patient who has RA and refractory atopic dermatitis and already is on MTX 25 mg weekly?  

No. Unless the problem has been chronic since childhood, I would first run through the diagnostic checklist for adult-onset generalized dermatitis to be sure this is not a mimic of AD. If no other diagnosis is established after a thorough investigation, I would stop adalimumab and change to upadacit...

If the question is "is it safe to add dupilumab to adalimumab + methotrexate", then my answer would be yes, I think it is. I agree with Dr. @Nedorost that it'd make a ton of sense to switch to upadacitinib to treat both disorders instead of using three drugs in combination, as although my answer is...