Alemao E, et al. - Here, researchers assess the relationship between the presence of anti-cyclic citrullinated protein antibodies (anti-CCP) and rheumatoid factor (RF) and other outcomes, including joint erosions and both clinical and economic endpoints, in patients with rheumatoid arthritis (RA). For the first time in a "real-world" setting incorporating patients with both recent-onset and chronic RA, this study showed that the combination of anti-CCP seropositivity and erosions was significantly connected with more adverse clinical and health-economic consequences, including a lower probability of low disease activity and higher health resource utilization, despite utilization of biologic disease-modifying antirheumatic drugs by many patients. This dual presentation may signal a requirement for more intensive therapies, even when seen in patients with chronic, and also recent-onset, RA.