OBJECTIVES: To describe the use of biologics, in the treatment of rheumatoid arthritis (RA), in a real life Canadian setting. METHODS: Patients covered by the Quebec provincial drug reimbursement program (RAMQ) who had a diagnosis of RA and had used at least one biologic in the period from January 1, 2001 to June 30, 2011 were selected. Agents included in the study were adalimumab, etanercept, infliximab, abatacept, anakinra, golimumab, rituximab, tocilizumab and ustekinumab, as they were all reimbursed by the drug program. The use of biologics was analyzed in terms of patient  characteristics, treatment patterns and costs. RESULTS: A total of 4225 patients were included in this study. The average age was 51.1 years (SD=14.6), and there was a higher proportion of women (69.9%). About two-thirds of patients (63.3%) had only a diagnosis of RA, while 36.7% had two or more concomitant diagnoses, such as psoriasis (15.9%) and psoriatic arthritis (11.5%). During the course of the study period, most patients used only one biologic (78.3%). The number of biologic scripts increased by an annual rate of 25% over the last 5 years; from 12,926 scripts in 2006 to 26,491 in 2010. Out of the total 135,616 scripts for a biologic, 74,058 were for etanercept (54.6%), 27,994 for adalimumab (25.9%), and 23,858 for infliximab (17.6%). Concomitant use of methotrexate decreased over time from 60.3% in the first year following initiation of the biologics to 44.2% in the fourth year. Average annual cost for biologics was $17,040 per patient and did not vary significantly over time.  CONCLUSIONS: RA is a complex disease. More than a third of the patients studied had concomitant inflammatory diseases. Biologics use increased over time, and there was a marked reduction in the use of concomitant methotrexate four years after biologic initiation.