Carotid Atherosclerosis and T-Cell Imbalance in Women with Rheumatoid Arthritis: A Cross-Sectional Study of Intima–Media Thickness, Anti-CCP Antibodies and CD4/CD8 Ratio

Background: Rheumatoid arthritis (RA) is associated with increased cardiovascular risk beyond traditional risk factors. Carotid intima–media thickness (IMT) is a marker of subclinical atherosclerosis and may be influenced by chronic inflammation in RA. Objectives: This study aimed to compare carotid IMT between women with RA and age-matched controls, and to investigate the associations between IMT and RA-related factors, including disease duration, menopausal status, anti-cyclic citrullinated peptide (anti-CCP) antibodies and the CD4/CD8 T-cell ratio. Methods: This cross-sectional study included 59 women with RA and 55 age-matched controls. All RA patients received methotrexate and had no recent biologic DMARD exposure. Carotid IMT was measured by B-mode ultrasonography. Clinical, laboratory, and immunologic parameters, including anti-CCP antibodies and CD4/CD8 ratio, were analyzed. Results: Mean carotid IMT was significantly higher in RA patients than in controls (0.85 ± 0.09 vs. 0.63 ± 0.08 mm, p < 0.0001). Within the RA group, IMT correlated positively with disease duration (r = 0.48, p < 0.001), years since menopause (ρ = 0.44, p = 0.001), anti-CCP titers (r = 0.31, p = 0.018) and CD4/CD8 ratio (r = 0.42, p < 0.001), and inversely with CD8 T-cell counts (r = −0.34, p = 0.009). In multivariable analysis, RA duration and CD4/CD8 ratio remained independently associated with IMT after adjustment for age, lipids and blood pressure. Conclusions: Women with RA had greater carotid IMT than age-matched controls. Longer disease duration and a higher CD4/CD8 ratio were independently associated with IMT, supporting a link between cumulative disease burden, T-cell imbalance and subclinical carotid atherosclerosis in RA. These findings support routine cardiovascular risk assessment and consideration of vascular imaging in high-risk RA subgroups.