BACKGROUND Cardiovascular (CV) morbidity and mortality are increased in patients with rheumatoid arthritis (RA). Our study aim was to determine the relationship between carotid artery intima-media wall thickness (IMT) and flow-mediated endothelium-dependent vasodilatation (FMD) in a patients with RA, in context with clinical and laboratory measurements. METHODS Fifty-two patients with RA and 30 matched healthy controls without clinically evident CV disease were studied. Brachial and carotid ultrasonography was performed to determine FMD and IMT, respectively. We also assayed immunological, inflammatory and metabolic laboratory markers. RESULTS IMT was significantly higher in RA patients (1.00 ± 0.16 mm) patients than in controls (0.89 ± 0.13 mm) (P = 0.001). FMD was significantly lower in RA (9.16 ± 7.03) as compared to controls (12.60 ± 5.49) (p = 0.005). RA patients had significant positive correlations between erythrocyte sedimentation rate (ESR) (r=0.395 p = 0.021) and IMT and negative correlation between visual analog scale (VAS) (r= -0.311, p= 0.025) and IMT. RA patients who used low doses of corticosteroids have, statistically, significantly better FMD, than those who do not use corticosteroids. Linear regression analysis revealed that IMT was related to tender joint count (p = 0.008), VAS (p < 0.001), ESR (p = 0.048) and total cholesterol/high density lipoprotein cholesterol ratio (p = 0.039). CONCLUSIONS In patients with RA, FMD was impaired and IMT was increased, indicating early endothelial dysfunction and accelerated atherosclerosis. Early treatment of disease may reduce the risk of atherosclerosis in RA.