What is the number one cause of death in patients with rheumatoid arthritis?

• A. Sepsis
• B. Cancer
• C. Arteriosclerotic cardiovascular disease
• D. Liver failure

Answer: (C)

Chronic systemic inflammation in rheumatoid arthritis accelerates atherosclerosis, so cardiovascular disease becomes the primary cause of death. The ongoing inflammatory milieu promotes endothelial dysfunction, abnormal lipid metabolism, and a pro-thrombotic state, leading to more plaque formation and a higher risk of heart attacks and strokes. This increased cardiovascular mortality remains a dominant issue even when other risks like infections or cancer are considered, though those risks exist, especially with certain therapies. Therefore, controlling inflammation and aggressively managing cardiovascular risk factors—lipids, blood pressure, smoking, activity—are crucial to improve survival in RA.