With growing insight into the pathogenesis of rheumatoid arthritis (RA), the identification of its preclinical evolution and implementation of preventive interventions has emerged as a critical opportunity to delay or even halt disease onset. This review summarizes recent advances in understanding the immunological activation networks of preclinical RA (Pre-RA) and developments in risk prediction. We emphasize that strategies for high-risk population identification， including ACPA-positive individuals and clinically suspect arthralgia (CSA) patients， are becoming increasingly multifaceted. The integration of antibody profiles, imaging features, clinical parameters, and multi-omics biomarkers has enabled the preliminary establishment of risk-stratification frameworks, laying the foundation for tailored intervention strategies. We therefore call on rheumatology clinicians to recognize the importance of this early disease window, strengthen multicenter collaboration in Pre-RA research, advance the standardization and localization of high-risk identification tools, and construct a closed-loop system of “identification-stratification-intervention-follow-up” to facilitate precision prevention and control of preclinical RA