Eligibility Criteria:
Inclusion Criteria:
Male and female patients, 18 to 75 years of age, with active rheumatoid arthritis (RA) who have had an inadequate response to disease modifying anti-rheumatic drugs, not more than 3 non-biological DMARDs including leflunomide, and not more than one inadequate response to anti-TNF-therapy, and currently have active disease despite at least 3-month treatment with leflunomide. Active disease is defined as DAS 28 \>3.2 and at least swollen joint count (SJC) ≥ 3 and tender joint count (TJC) ≥ 3 included in the 28 joint count.
* Male and female patients with rheumatoid arthritis for at least 3 months diagnosed according to the revised 1987 ACR criteria for the classification of rheumatoid arthritis.
* Willingness and capability to give written informed consent, and willingness to participate and to comply with the study protocol.
* Not more than 2 non-biological DMARDs other than leflunomide in history, which are washed out at least 4 weeks prior to first rituximab infusion
* Previous use of anti-TNF therapy is allowed. Patient will only be allowed to be pre-treated with a maximum of two anti-TNF therapies and only one stopped due to inadequate response. The second anti-TNF could be stopped for instance due to intolerance, e.g. injection site reactions. Anti-TNF treatment must be discontinued prior to baseline considering the different characteristics of the specific compound: Use of infliximab, adalimumab, certolizumab, golimumab within 8 weeks of baseline, use of etanercept within 4 weeks of baseline.
Exclusion Criteria:
* RA functional class IV: limited in ability to perform usual self-care, work, and other activities
* Male and female patients with other chronic inflammatory articular disease or systemic autoimmune disease
* Any active infection, a history of recurrent clinically significant infection, a history of recurrent bacterial infections with encapsulated organisms (Hepatitis B, C and HIV (human immune deficiency virus) - will be tested at screening)
* Chronic, latent and acute infections of the lung
* Positive result of a Tuberculosis specific Interferon gamma release assay (will be tested at screening)
* Primary or secondary immunodeficiency
* History of cancer with curative treatment not longer than 5 years ago except basal-cell carcinoma of the skin that had been excised
* Evidence of significant uncontrolled concomitant diseases or serious and / or uncontrolled diseases that are likely to interfere with the evaluation of the patient's safety and of the study outcome
* Neuropathy that can interfere with filling out the patient's questionnaires
* History of a severe psychological illness or condition
* Known hypersensitivity to any component of the product or to murine proteins
* Severe heart failure (New York Heart Association Class III and IV) or severe,uncontrolled cardiac disease.
* Women lactating, pregnant, nursing or of childbearing potential with a positive pregnancy test or planned pregnancy.
* Women of childbearing potential without adequate contraception (medically acceptable methods (pearl Index \< 1) are contraceptive implant, contraceptive injection, intrauterine device (IUD), or oral contraceptives taken for at least 3 months,which the patient agrees to continue using during the study, or a double-barrier method which must consist of a combination of any of the following: diaphragma,cervical cap, condom, or spermicide)
* History of alcohol, drug or chemical abuse (defined as impaired / questionable reliability) as well as neurotic personality.
* Participation in another investigational study within 4 weeks prior to the screening visit.
* Previous treatment with any B-cell depleting agents including rituximab
* Intolerance to ingredients of rituximab or murine proteins
* Pre-treatment with abatacept, tocilizumab or other anti-TNF biologicals.
* Inadequate response to more than one anti-TNF-therapy
* Pre-treatment of more than two anti-TNF, only one is allowed to be stopped due to inadequate response. The second anti-TNF could be stopped due to intolerance, e.g. injection site reactions
* Corticosteroids at doses exceeding 10 mg per day of prednisolone or equivalents within the last 2 weeks or corticosteroids at instable doses within the last 2 weeks
* Intolerance or contraindication to drugs required for the treatment of the side effects of rituximab
* Previous treatment with any investigational medicinal product within last 3 months prior to baseline
* Receipt of a live vaccine within 4 weeks prior to treatment
* Intra- articular or parenteral corticosteroids within 4 weeks prior to screening visit
* Haemoglobin \< 8.5 g / dl (equivalent to \< 5,28 mmol/l Haemoglobin)
* Neutrophil counts \< 1.500 / μl (equivalent to 1,5 / nl)
* Platelet count \< 75.000 / μl (equivalent to 75 / nl)
* Lower than 500 / μl (equivalent to 0,5 / nl) lymphocytes
* Serum creatinine \> 1.4 mg / dl for women or 1.6 mg / dl for men
* Aspartate aminotransferase (AST) or Alanine aminotransferase (ALT) \> 2.5 times upper limit of normal
* IgG (immunoglobulin G) level \< 5g/l