Kelmenson LB, Wagner BD, McNair BK, et al. - A total of 214 RA cases and 210 matched controls were recognized via the Department of Defense Serum Repository in order to assess patterns of rises of isotypes of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) before and after RA diagnosis. In cases vs controls, raised pre-RA autoantibody levels were noted. The autoantibodies as positive/negative exhibited comparable associations. Only ACPA-IgA positivity notably grew post-RA. All autoantibody levels showed an early initial rise, a period of stability, then rise quickly pre-RA diagnosis. A pre-RA endotype of the early rise of autoantibodies was related to the extended use of biologic therapy, and a greater prevalence of sicca symptoms and lung disease post-RA. In understanding the pathophysiology of RA development, variations in patterns of elevations of autoantibody isotypes were found out to have suggestions. Furthermore, these involve learning what factors motivate primary autoantibody rises in comparison with what factors (including mucosal) excite later raises in autoantibodies and a shift to clinically-apparent RA, and how pre-RA endotypes may affect post-RA phenotypes.