Background: RA is a chronic systemic inflammatory disorder with a prevalence of up to 1%. In the absence of adequate treatment, progressive joint deformity and loss of function occurs with associated premature cardiovascular morbidity. Tocilizumab (TCZ) [1], a humanized anti IL-6 receptor (anti IL-6R) antibody, has been shown in several large randomized controlled trials to be efficacious and well tolerated in the treatment of RA. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.