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

• A. Infections
• B. Cardiovascular disease (CVD)
• C. Cancer
• D. Kidney failure

Answer: (B)

Chronic systemic inflammation in rheumatoid arthritis accelerates atherosclerosis and alters lipid metabolism, making cardiovascular disease the leading cause of death for these patients. The inflammatory environment promotes endothelial dysfunction, plaque instability, and a pro-thrombotic state, increasing the risk of heart attack and stroke beyond what age and traditional risk factors would predict. Controlling RA activity helps reduce this risk, while factors common in RA—long-term steroid use, obesity, dyslipidemia, hypertension, and insulin resistance—can further elevate cardiovascular risk. Infections can contribute to mortality, especially with immunosuppressive therapy, but they are not the top cause overall. Cancer risk is modestly increased for some cancers, but again not the primary cause of death. Kidney failure is not the leading cause.