There was a significant difference in circulating Gal-9 between those with and without advanced articular lesions (stage II–IV) in RA patients with low titers of ACPA (7367 pg/ml [IQR 5931–10,109] versus 7009 pg/ml [IQR 4602–9450], p = 0.004). This evidence concerns the gene LGALS9 and rheumatoid arthritis.