Rheumatoid arthritis (RA) is a multifaceted autoimmune disorder characterized by chronic joint inflammation, leading to progressive disability and significantly impacting patients’ quality of life. The exact mechanisms underlying RA pathogenesis remain unclear. Epicardial adipose tissue (EAT), a metabolically active form of adipose tissue, has been linked to systemic inflammation and increased cardiovascular risk. One emerging area of research in RA is the role of EAT in the pathogenesis of the disease. This study aims to investigate the relationship between EAT and clinical and laboratory features in patients with RA. A total of 342 patients were recruited from the rheumatology department of a single center cross-sectional study. The participants were divided into two groups: 200 patients with RA and 142 age-matched healthy controls (HC). Laboratory and radiology results were obtained from the electronic registration database. Data were analyzed and compared between groups. EAT was measured using computed tomography (CT), and its correlations with clinical features and inflammatory markers were evaluated. EAT was found to be significantly higher in the RA than HC. There was a strong positive correlation between EFV and activity score (DAS28) (p<0.001) and weak positive correlation between EFV and age, leukocyte, lymphocyte, RDW and CRP (p<0.05). The EAT did not differ significantly in terms of treatment. ROC analysis showed a moderate discriminatory power of EAT with an AUC of 0.604 (95% CI: 0.542-0.666, p<0.001) with a sensitivity of 69.0% and a specificity of 51.4% at a cut-off value of 123.68. EAT may be an indicator of active inflammation in RA patients.