Inflammation is the major factor driving the progression of structural damage in rheumatoid arthritis (RA); therefore, it is critical to achieve rapid suppression of inflammation to maximize disease control. The severity of inflammation and progression of joint damage varies from patient to patient. Some patients have the propensity to change slowly over time and then progress in a more rapid and dynamic fashion. In those where inflammation is more severe, extensive damage can occur within only a few years of disease onset. The progress of joint destruction, as assessed radiographically, results in a decline in functional capacity and quality of life. Consequently, the challenge for clinicians is to identify and treat those patients who develop rapid, progressive disease. Several biological markers and clinical indicators have been identified to help predict or establish which of the patients have rapidly progressing disease or who are at most risk for rapid progression. Early diagnosis of patients with rapidly progressing RA enables immediate and intensive intervention (e.g. with biologic therapy) and a greater opportunity to change the course of disease.