Carotid IMT has been shown to reduce in response to anti-tumour necrosis factor-α treatment in patients with RA . This raises the question as to whether, in states characterized by high-grade inflammation such as RA, carotid IMT reflects current inflammatory load rather than more permanent, structural vessel changes. If the former is true, then a 'high' carotid IMT measured during a 'flare' of disease activity may not be a good predictor of future cardiovascular events. This question has not been addressed in the study conducted by Gonzalez-Juanatey and colleagues . Their study lends credence to the continuing use of surrogates of atherosclerotic cardiovascular disease in patients with RA. However, we believe that the short-term and long-term interplay between degrees of systemic inflammation and surrogates that are thought to reflect functional or structural vessel changes, as well as the overall metabolic state of the individual patient, requires more investigation in longitudinal studies designed specifically for this purpose.IMT = intima-media thickness; RA = rheumatoid arthritis.The authors declare that they have no competing interests.