Cytomegalovirus as a driver of excess cardiovascular mortality in rheumatoid arthritis: a red herring or a smoking gun?

Rheumatoid arthritis (RA) is the most common inflammatory arthritis worldwide. Apart from its well known manifestations involving the joints (e.g. deformity, swelling, synovial inflammation), there are widespread, extra-articular manifestations that also involve the cardiovascular (CV) system. The consequences of CV involvement are often serious; cerebrovascular disease, ischemic heart disease and CV disease (CVD)-associated death are up to 50% higher in the context of RA leading to a reduction of life-expectancy in these patients of 3-10 years compared with the general population. To date, no satisfactory explanation of this phenomenon has been found, or maybe, it has been overlooked?