Rheumatoid arthritis (RA) starts several years before the first symptoms appear, such as pain or swelling in the joints. The new study followed people with antibody-associated RA for 7 years and found that already during this period, there is extensive inflammation and misactivity of immune cells such as B and T lymphocytes that are primed for an autoimmune attack. These immune changes also involve epigenetic reprogramming of cells that have not yet been exposed to direct damage, suggesting that the body has been preparing for the development of disease for a long time. Elevated levels of inflammatory proteins and autoimmune antibodies in the blood can identify at-risk individuals 3 to 5 years before clinical symptoms appear. However, not all people with these antibodies will develop the disease, complicating prevention and treatment. The results of the study may lead to earlier diagnosis and the development of preventive therapies that could halt or ameliorate the progression of RA before the joints are damaged[1][2][3].