Rheumatoid arthritis (RA) is considered as a connective tissue disease while ankylosing spondylitis (AS) is a prototype of spondyloarthritis. These diseases are seen concomitantly only very rarely. Also, rituximab has proven efficacy in the treatment of RA while its role in the treatment of AS is unclear. In this presentation, the concomitant presence of RA and AS in a 43-year-old male patient as well as the efficacy and safety of rituximab is discussed. Rituximab was given due to lack of response to treatment with anti-TNF-alpha. Evaluations made at the 6th and 12th months of treatment showed complete response for RA and partial response for AS. 1. Introduction Ankylosing spondylitis (AS) is a chronic inflammatory disease which primarily affects the sacroiliac joint and axial and peripheral joints [1]. It should typically be considered in young male patients with complaints of inflammatory lower back pain. Rheumatoid arthritis (RA), however, is a connective tissue disease which can lead to erosive arthritis and results in significant morbidity and mortality [2]. These diseases have different mechanisms of etiopathogenesis and they are rarely seen in the same person. Although the term “rheumatoid spondylitis” is used to describe the cervical involvement of RA, it can also be used for people who have both diseases concomitantly. Different disease-modifying antirheumatic drugs (DMARDs) are used for the treatment of these diseases [3]. The efficacy and safety of rituximab (RTX), in addition to DMARDs and anti-TNF-alpha drugs, have been proved in the treatment of RA. RTX is a chimeric monoclonal antibody targeted against CD20 which is used in RA patients who do not respond to treatment with one or more anti-TNF-alpha drugs [4]. Various studies have shown that it can be effective in other autoimmune diseases too [5, 6]. Anti-TNF-alpha drugs have revolutionized the treatment of AS by shaping the course and prognosis of the disease in the axial and peripheral involvement of AS [7]. However, disease activity canot be controlled with TNF-blockers in 50% of AS patients. Therefore, other treatment options are considered urgently in cases where anti-TNF-alpha drugs do not lead to a response and/or are contraindicated. Histological and MRI studies showed that the primary area of inflammation in AS is the cartilage and bone surface [8]. Mononuclear cell infiltration was detected in the cartilage and subchondral bone. Infiltrations, primarily of macrophages and T-cells, with specific immune response were identified in early and active sacroiliitis [9]. Surprisingly,
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