A relatively newer biologic, rituximab, provides an alternative strategy for treating the presenting patient. Rituximab, a chimeric anti-CD20 monoclonal antibody produced by genetic engineering, exerts its therapeutic action by selectively targeting CD-20 positive B cells1212, 18. Since CD-20 is expressed exclusively on pre-B and mature B lymphocytes; Stem cells and plasma cells are not implicated in rituximab therapy. Overexpression of B cells expressing the CD-20 surface antigen in the synovium of joints affected by rheumatoid arthritis has been well established 18 . The potential mechanisms by which these B cells contribute to the immunopathogenesis of rheumatoid arthritis are as follows: they can act as antigen-presenting cells, secrete proinflammatory cytokines (including tumor necrosis factor alpha), and generate rheumatoid factor (RF) and other autoantibodies also activating T12 cells. Therefore, rituximab-mediated B cell depletion is thought to prevent the occurrence of these potential mechanisms, thereby controlling disease progression18. Rituximab therapy consists of two 1000 mg infusions, administered two weeks apart at intervals of no less than 2 weeks. The expected cost of a single course of rituximab therapy is approximately £349,211 and, if clinically effective, would offer the patient a more cost-effective dosing schedule than anti-TNF therapy. The annual cost, however, depends on the frequency with which the patient must undergo a course of rituximab therapy11. An RCT aimed at studying different dosing regimens of rituximab in methotrexate-resistant patients, called the DANCER study, provides significant evidence demonstrating the potential benefit of rituximab therapy19. As part of the study, patients received rituximab 500 mg, rituximab 1000 mg, or placebo... focus of paper... 50 (7): 754--766.27. Kaneko A. Tocilizumab in rheumatoid arthritis: efficacy, safety and its place in therapy. Therapeutic advances in chronic disease. 2013; 4 (1): 15--21.28. An M, Zou Z, Shen H, Zhang J, Cao Y, Jiang Y. The addition of 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.