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To the Editor: I read with interest the original article by Edwards et al about the possibility of rheumatoid factor (RF) being an independent risk factor for ischaemic heart disease.1 The contribution of inflammation to the initiation and progression of coronary atherosclerosis is well established. I agree this study adds support to the importance of inflammation in atherosclerosis. The concept of autoimmunity and the direct role of RF in the pathogenesis of the atherosclerotic disease process are fascinating and will act as a basis for future research.
The key unanswered question is whether RF is a marker of inflammation or an independent risk factor for ischaemic heart disease. As acknowledged by the authors, it may be difficult to draw a firm conclusion from this cross‐sectional study. It might have been useful if the authors had correlated RF with well‐established markers of inflammation such as C reactive protein.2 Screening patients using RF is probably not justified at present until further research is carried out.