TNF and rheumatoid arthritis: The critical difference between the class of TNF inhibitors and TCZ or B-cell depletive agent rituximab is that infliximab, an anti-TNF monoclonal antibody, may negatively address gingival inflammation although it may also improve alveolar bone destruction [5,6,7,19,37] resulting in a dissociated response for patients with severe periodontitis [5], while both tocilizumab and rituximab associate with significant a down regulation of gingival inflammation and damage in RA associated with periodontitis [16,17,27,28,50].