In a single-center longitudinal study of Leeds cohorts, 63 patients with palindromic rheumatism who progressed to persistent inflammatory arthritis were followed to assess whether flare patterns predicted disease location. Among 48 patients with complete joint-level data, persistent inflammatory arthritis developed in at least one previously affected joint in 71% of patients, and prior involvement of a joint during a flare was associated with about twofold higher odds of arthritis in that same joint. Hands and shoulders were the most common sites at initial flare, and small joints of the hands predominated overall. At progression, most affected joints had been involved during earlier flares. Patients who progressed to rheumatoid arthritis after a palindromic rheumatism prodrome had higher swollen joint counts but lower disability, pain, and fatigue compared with at-risk patients without palindromic rheumatism, despite similar disease activity.