Background: Atherosclerosis is a slowly progressive diffuse degenerative disease of arteries which can lead to various metabolic and cardiovascular complications. However, it can cause early and significant morbidity in patients with Rheumatoid Arthritis (RA) when compared to general population. Indirect evidence of accelerated atherosclerosis in RA comes from studies measuring carotid artery intima media thickness (CIMT). This present study aims to investigate the relationship between carotid intima-media thickness and clinical and metabolic features in rheumatoid arthritis (RA) patients. Methods In this prospective observational case control study, 34 patients with RA having a disease duration of more than 5 years were compared to 34 healthy matched controls. All the patients and controls were asymptomatic for atherosclerosis and had no traditional risk factors for atherosclerosis. Both groups underwent high frequency carotid ultrasound and Doppler examination for CIMT in addition to detailed history, physical examination and measurement of other metabolic parameters. Results The mean ages of RA group and the control group were 48±14.4 and 48.6±14.0 respectively with a female preponderance in the RA group. The groups were comparable for atherogenic biochemical risk indices such as body mass index (BMI), systolic and diastolic blood pressure, random blood sugar, and lipid profile. The RA group had a significant elevation of CRP as compared to the control group (88% vs 15%). The mean CIMT of the RA group was 0.86 ± 0.18 and that of the control group was 0.53 ± 0.15, a difference which was statistically significant (p<0.0001). As the severity of disease increased according to disease activity score (DAS 28), the CIMT in study group also showed an increasing trend. Conclusions RA is a chronic disease associatedd with chronic subclinical inflammation. In view of the consequentr high risk of atherosclerosis seen in these patients CIMT may serve as an early surrogate marker of atherosclerosis. We can identify these high risk subgroups of patients with a simple, reliable, inexpensive, and non-invasive bedside carotid Doppler sonogram even in resource poor countries such as India. In our view physicians should be vigilant to identify and screen regularly for atherosclerosis with CIMT in RA patients, so that prompt early management can prevent the cardiovascular complications.