We do not consider that ACPA positivity is likely to have given rise to a subsequent RF response in the RA patients studied here as a study of the RF isotypes (IgM, IgG and IgA) in individuals who subsequently developed RA were more likely to be present before the development of various ACPAs (fibrinogen, α-enolase, triple helical collagen type II, filaggrin and vimentin). Here, VIM is linked to rheumatoid arthritis.