Despite having a similar response to steered treatment strategies, ACPA-positive patients with RA indeed have higher rates of joint damage progression over time [9], and serum receptor activator of nuclear factor kappa B ligand (RANKL) is reported to be increased in ACPA-positive patients independent of acute phase reactants and pro-inflammatory cytokines [10]. This evidence concerns the gene TNFSF11 and rheumatoid arthritis.