Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease characterized by inflammation of synovial joints in a symmetrical pattern leading to destruction of cartilage and bone, joint deformities, permanent functional impairment and disability. RA is the most common inflammatory arthritis, with a lifetime prevalence of 1% worldwide.Rheumatoid arthritis being a chronic inflammatory disease is known to be associated with a variety of immune alterations. Neutrophil infiltration of synovial tissue with increased levels of inflammatory cytokines like TNF-alpha, IL-1, IL-6, oxidative damage, premature thymus aging and dysfunction, and lymphopenia with presence of abnormal senescent peripheral T cells due to selective destruction of some T cell subsets, microcirculatory thrombosis and reactive thrombocytosis due to inflammation induced anemia and increased erythropoietin levels and neutrophil induced platelet activation are recognized features of RA. Therefore, neutrophilia, lymphopenia and thrombocytosis are known immune alterations in RA which may be reflected in altered relative proportions of these cells in the peripheral blood. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to lymphocyte ratio (PLR) have come increasingly in focus as indicators of subclinical systemic inflammation which can be used to assess disease activity and prognosticate for a variety of infective, inflammatory, neoplastic and autoimmune conditions including RA. We studied complete blood count(CBC) parameters including Neutrophil-Lymphocyte ratio, Platelet-Lymphocyte ratio and RDW as markers of inflammation and disease severity in patients of rheumatoid arthritis after 8 weeks of methotrexate therapy. The study found that apart from DAS 28, RDW, PLR and NLR are emerging inflammatory biomarkers which could be used to evaluate disease activity in active RA patients.