A relatively newer biologic, rituximab offers an alternative strategy to treat the presenting patient. A genetically modified chimeric anti-CD20 monoclonal antibody, rituximab exerts its therapeutic action by selectively targeting CD-20-positive B lymphocytes1212, 18. CD-20 being expressed exclusively on pre-B and mature B lymphocytes; Stem cells and plasma cells are not involved in rituximab treatment. The overexpression of B lymphocytes expressing the surface antigen CD-20 in the synovium of RA joints is well established18. Potential mechanisms by which these B cells contribute to the immunopathogenesis of RA include the following: they may act as antigen-presenting cells, secrete pro-inflammatory cytokines (including tumor necrosis factor alpha), and generate tumor necrosis factor alpha. rheumatoid (RF) and other autoantibodies while also activating T12 cells. Therefore, rituximab-induced B cell depletion is thought to prevent these potential mechanisms from occurring, thereby controlling disease progression18. Rituximab treatment consists of two 1,000 mg infusions, given two weeks apart, at least 2 weeks apart. The projected cost of a single treatment with rituximab is approximately £349,211 and, if clinically effective, would provide the patient with a more convenient dosing regimen compared to anti-TNF treatment. The annual cost, however, depends on how often the patient must undergo treatment with rituximab11. An RCT to study different rituximab dosing regimens in methotrexate-resistant patients, called the DANCER trial, provides significant evidence demonstrating the potential benefit of rituximab treatment19. In the trial, patients received rituximab 500 MG, rituximab 1000 mg, or placebo...... middle of paper ......50(7):754--766.27. Kaneko A. Tocilizumab in rheumatoid arthritis: effectiveness, safety and its place in therapy. Therapeutic advances in chronic diseases. 2013; 4 (1): 15--21.28. An M, Zou Z, Shen H, Zhang J, Cao Y, Jiang Y. Adding tocilizumab to DMARD therapy for rheumatoid arthritis: a meta-analysis of randomized controlled trials. European Journal of Clinical Pharmacology. 2010; 66 (1): 49--59.29. Schmitt C, Kuhn B, Zhang X, Kivitz A, Grange S. Disease-drug-drug interaction involving tocilizumab and simvastatin in patients with rheumatoid arthritis. Clinical and therapeutic pharmacology. 2011; 89 (5): 735-740.30. Ding T, Ledingham J, Luqmani R, Westlake S, Hyrich K, Lunt M, Kiely P, Bukhari M, Abernethy R, Bosworth A, others. Rheumatoid Arthritis BSR and BHPR Guidelines on the Safety of Anti-TNF Therapies.Rheumatology. 2010; 49 (11): 2217--2219.