ABSTRACT Purpose: To evaluate the retinal vascular changes related to early Rheumatoid Arthritis (RA) and to correlate these changes with disease activity. Methods: 108 eyes of 54 early RA patients and 66 eyes of 33 age and sex-matched healthy participants underwent Optical Coherence Tomography Angiography (OCTA) examination to evaluate superficial (SCP), deep retinal capillary plexus (DCP), and radial peripapillary capillaries (RPC), we collected Values of the vessel density (VD) of SCP and DCP, central foveal thickness (CFT), foveal avascular zone (FAZ) along with a full rheumatological examination and disease activity score by (DAS28). Results: RPC values were significantly lower among RA patients in all subfields apart from the temporal one. There was a significant difference between RA patients and healthy controls in foveal and all perifoveal measurements, except the nasal perifoveal region. Also, the FAZ value was significantly higher in RA patients. We performed Spearman’s correlation between OCTA and RA disease parameters and detected a negative correlation between the duration of disease-related symptoms and RPC and parafoveal measurements and between DAS-28 and foveal measurements. A significant positive correlation between anti-CCP titer and FAZ measurements was detected among RA patients. Conclusion: OCTA can detect early retinal microcirculation affection in RA patients in the form of a reduction in the vascular density in most of the subfields of the peripapillary area as well as the fovea, perifoveal, and parafoveal areas. The results of the current study can provide new insight into the applications of OCTA as a diagnostic tool in RA patients’ assessment and follow-up.