ABSTRACT: INTRODUCTION: In this study we aimed to investigate whether there are indications of premature atherosclerosis, as measured by flow-mediated dilation (FMD) and intima media thickness (IMT), in patients with very early RA, and to analyze its relation to biomarkers of endothelial dysfunction, taking inflammation and traditional cardiovascular disease (CVD) risk factors into account. METHODS: Patients from the three northern counties of Sweden diagnosed with early RA are followed in an ongoing prospective study of CVD co-morbidity. Of these, all patients aged [less than or equal to]60 years were consecutively included in this survey of CVD risk factors (n=79). Forty-four age and sex matched controls were included. IMT of common carotid artery and FMD of brachial artery were measured using ultrasonography. Blood was drawn for analysis of lipids, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA)-mass, VonWillebrand factor (VWF), soluble intercellular adhesion molecule-1 (sICAM), soluble vascular cell adhesion molecule-1 (sVCAM), sE-selectin, sL-selectin and monocyte chemotactic protein-1 (MCP-1). In a subgroup of 27 RA patients and their controls the ultrasound measurements were reanalysed after 18 months. RESULTS: There were no significant differences between RA patients and controls in terms of IMT or FMD at the first evaluation. However after 18 months there was a significant increase in the IMT among the patients with RA (P