Current versus cumulative inflammatory burden A possible explanation for the discrepant findings is the way the impact of inflammation on the vasculature is viewed. Although acute bouts of inflammation are important, the inflammatory burden over a period of time may be more crucial for the progression of vascular dysfunction [6]. Furthermore, the long-term metabolic effects of inflammation may lead to the development or deterioration of several classical CVD risk factors [7]. In RA, inflammation levels constantly fluctuate and the endothelium is exposed to varying inflammatory loads. Patients with greater periods of elevated systemic inflammation may develop more damage to the endothelium due to the higher cumulative inflammatory burden on the vasculature. Thus, characterizing the inf lammatory f luctuations over a period of time (cumulative inflammatory burden) may be a better predictor for vascular dysfunction in RA. Such an approach takes into account the inflammatory load during the course of the disease, with high inflammatory load likely to result in greater progression of atherosclerosis [6]. Indeed, studies have shown that when compared with current inflammatory levels, cumulative inflammation shows better association with vascular assessments characterizing different stages of atherosclerosis (i.e., vasodilatory function, arterial stiffness and carotid intimamedia thickness [cIMT]), reviewed in [3]. In line with this evidence it is tempting to speculate that continuous inflammatory insult may be more likely to lead to vascular impairments, but further studies that explore relationships between cumulative inflammation and vascular Rheumatoid arthritis (RA) is the commonest inf lammatory arthritis and associates with an increased risk for cardiovascular disease (CVD) [1]. Classical CVD risk factors along with systemic disease-related inflammation can both negatively impact upon the vasculature in RA [1]. During the last decade, there has been an abundance of studies that have examined peripheral vascular function and morphology in patients with RA. The advantage of these assessments is that they are noninvasive, relatively simple to perform and show, in the general population, good correlation with assessments of coronary endothelial function [2]. However, despite a number of advances in vascular rheumatology research, there are still several important issues that need to be addressed in future studies.