In developing countries, rheumatoid arthritis (RA) remains
a seriously under-prioritised disease, particularly among the
underprivileged, often resulting in presentation of patients
late in the course of their disease, further complicated by
limited therapeutic options and inconsistent follow up. The
consequences are often severe with irreversible disability,
increased frequency of co-morbidities, especially cardiovascular
disease (CVD), and higher mortality rates, relative to
developed countries. Despite addressing traditional cardiovascular
risk factors, the impact of subclinical or ‘residual’
inflammation from uncontrolled RA needs to be considered.
This narrative review explores the prevalence and pathogenesis
of CVD in RA, including the impact of tobacco use. It
discusses pitfalls in the risk assessment of CVD in patients
with RA, and the effect of disease-modifying anti-rheumatic
therapy on cardiovascular co-morbidity.