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Psoriasis is a chronic inflammatory skin disease that often precedes the development of psoriatic arthritis. Advances over the past 10 years have deepened our understanding of the transition from skin inflammation to joint inflammation, revealing various phases during which genetic, environmental, and immunological factors can affect this transition. In 2023, a European Alliance of Associations for Rheumatology task force outlined key considerations for identifying individuals with subclinical disease from those with clinically stabilised disease. Discerning between subclinical psoriatic arthritis and very early disease is crucial and raises doubts and questions about when an individual transitions from being at risk to having established psoriatic arthritis. Labelling this stage as very early psoriatic arthritis rather than subclinical disease might have substantial clinical and therapeutic implications. This Viewpoint highlights the importance of precisely identifying the different stages of progression of psoriatic arthritis for timely interventions and better outcomes for patients., Competing Interests: Declaration of interests FC reports consulting fees from Eli Lilly, AbbVie, Novartis, and Janssen; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Eli Lilly, AbbVie, Alfasigma, Fresenius, GSK, Bristol Myers Squibb, Pfizer, Galapagos, UCB, and Janssen. SG reports consulting fees from Janssen and Boehringer Ingelheim; and support for attending meetings or travel from AbbVie, Novartis, and Pfizer. RC reports consulting fees from AbbVie, Alfasigma, and Eli Lilly; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AbbVie, Alfasigma, Eli Lilly, Pfizer, UCB, Fresenius, Galapagos, and Janssen; and participation on a data safety monitoring board or advisory board for Alfasigma and Galapagos. JUS reports consulting fees from Bristol Myers Squibb, Janssen, and UCB; and leadership or fiduciary roles in other board, society, committee, or advocacy groups, paid or unpaid, from the US National Psoriasis Foundation., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Sjögren's disease is a clinically and pathophysiologically heterogeneous disease to which precision medicine, on the basis of clinical and biological heterogeneity, has been not always applicable. In patients with Sjögren's disease, the relationship between dysregulated biological pathways and symptoms such as fatigue and pain or clinical manifestations is often difficult to establish. This clinical and biological dissociation also poses challenges when defining appropriate clinical endpoints for clinical trials. In the last few years, however, research efforts have been focused on gaining a better understanding of the considerable heterogeneity of Sjögren's disease by developing stratification models aimed at clustering patients with this condition into homogenous subgroups characterised by distinctive molecular signatures, biomarkers, clinical features, and outcomes. In this Review, we discuss current evidence regarding clinical, laboratory, histological, and biomolecular stratification in Sjögren's disease and examine how available stratification data can guide precision medicine and inform the design of future clinical trials., Competing Interests: Declaration of interests MB reports an unrestricted grant from Janssen, consulting fees from Ono Pharma, honoraria for lectures from GSK, and participation in scientific advisory boards for Janssen and Horizon Therapeutics. XM reports consulting fees from Bristol Myers Squibb, Galapagos, GSK, Novartis, Pfizer, and Servier. FC reports consulting fees from Eli Lilly, AbbVie, Novartis, GSK, Pfizer, Galapagos, UCB, Janssen, MSD, and AstraZeneca; honoraria for lectures from Eli Lilly, AbbVie, Novartis, GSK, Pfizer, Galapagos, UCB, Janssen, MSD, and AstraZeneca; and support for attending meetings or travel from Novartis, AbbVie, UCB, Eli Lilly, Pfizer, and Galapagos. SJ and J-OP declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Increased research over the past 30 years has greatly improved the understanding of the pathophysiological mechanisms and clinical aspects of autoantibody-positive rheumatoid arthritis, resulting in improved management and outcomes. In contrast, the subset of rheumatoid arthritis that does not have autoantibodies (such as rheumatoid factor and anti-citrullinated protein autoantibodies) remains less well defined in its pathogenic mechanisms. Autoantibody-negative rheumatoid arthritis continues to pose diagnostic challenges, might respond differently to therapies, and appears to be burdened with different comorbidities and outcomes. The clear separation of rheumatoid arthritis according to serotypes is still a subject of uncertainty and controversy, and studies specifically focused on comparing rheumatoid arthritis and rheumatoid arthritis-like arthritides that do not have autoantibodies remain scarce. The purpose of this Review is to summarise the peculiarities that make autoantibody-negative rheumatoid arthritis different from its autoantibody-positive counterpart, with the aim of generating debate and stimulating further research on this challenging condition., Competing Interests: Declaration of interests SB reports grant or research support from Pfizer, and personal fees and speaking honoraria from AbbVie, Alfasigma, Bristol Myers Squibb, Fresenius Kabi, Lilly, and Pfizer. FC reports consulting fees and speaking honoraria from AbbVie, Astra Zeneca, Galapagos, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, and UCB. CM reports consulting fees and speaking honoraria from AbbVie, Amgen, Bristol Myers Squibb, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, and Roche. All other authors report no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)