The ability to intervene at the earliest phases in the pathogenesis of a chronic rheumatic disease caused by auto-inflammatory, autoimmune, or tissue injury mechanisms has th epotential to prevent disease manifestations and consequences, limited loss of quality of life, comorbidity, and costs to society. This issue is dedicated to exploring the stages of rheumatic disease, biologic mechanisms contributing to the pathogenesis along with possible ways to study and screen for persons at risk with the ultimate goal of finding ways to prevent these devastating diseases.