About 30% of patients with rheumatoid arthritis fail to achieve a marked clinical response to tumour necrosis factor (TNF)α inhibitors.¹ Rituximab, a chimeric monoclonal antibody, selectively depletes human CD20-positive B cells.² In patients with rheumatoid arthritis with incomplete response to methotrexate (MTX), response with the addition of rituximab was superior to that with MTX alone.³ We carried out an observational study to assess the efficacy and safety of selective B cell depletion in the management of patients with rheumatoid arthritis refractory to TNFα inhibitors.

Ten patients fulfilling the 1987 American College of Rheumatology diagnostic criteria for rheumatoid arthritis⁴ and refractory to at least one anti-TNF agent for ⩾3 months were prospectively enrolled. Table 1 presents their clinical characteristics at baseline. All of them had active disease (median Disease Activity Score (DAS28) 5.28, interquartile range (IQR): 4.6–6.3).⁵