Netherlands: New research suggests that patients with clinically suspect arthralgia (CSA), a precursor stage of rheumatoid arthritis (RA), follow different symptom and disease progression pathways depending on their anti-citrullinated protein antibody (ACPA) status. Rheumatoid arthritis is categorized into ACPA-positive and ACPA-negative forms, which differ in their genetic and environmental risk factors. After reaching the CSA stage, ACPA-positive patients progressed to rheumatoid arthritis more rapidly than ACPA-negative patients. C-reactive protein levels rose more rapidly in ACPA-positive patients than in ACPA-negative patients. These findings highlight the potential need for ACPA-specific prevention strategies to delay or prevent the onset of rheumatoid arthritis.