Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease with articular and extra-articular manifestations, several factors can affect disease outcome. Objective: To assess the prevalence of obesity in a cohort of Egyptian rheumatoid arthritis patients and study its relation to disease activity and extra-articular manifestations. Patients and methods: The study included 200 RA patients. Detailed medical history, disease activity score (DAS28), VAS, HAQ, were carefully recorded. High-resolution computed tomography (HRCT) was done and to detect lung affection. BMI was calculated and patients were sub-grouped accordingly into underweight, normal BMI, over-weight and obese patients. Results: Patients were 172 females and 28 males with a mean age of 45.1±14.2 years. According to BMI, 32% of patients were overweight, 35% were obese, 20% with normal BMI and 13% were underweight. Overweight and obese patients were significantly older (p ˂ 0.001), had longer disease duration (p ˂ 0.001), had higher ESR, CRP, DAS, HAQ, VAS (p ˂ 0.001), had more frequent arthritis (p˂0.001), had joint deformity, had rheumatoid nodules (p = 0.007) and ILD (p ˂ 0.001). Conclusion: overweight and obesity were frequent among Egyptian RA patients. It was associated with high disease activity and extra-articular manifestations. In turn, patients' weight reduction can help in improvement of patients' outcome and disease activity control.