Background and Objectives: Variation in RANK/RANKL/OPG signaling may contribute to rheumatoid arthritis (RA) heterogeneity. We examined whether recorded TNFRSF11A exon 5–flanking variant carrier status was associated with six-month clinical outcomes in treatment-naïve RA. Materials and Methods: This prospective cohort included 57 patients: 10 carriers and 47 non-carriers. The primary outcome was six-month DAS28-CRP. Welch tests, Fisher’s exact tests, effect sizes, 95% confidence intervals, and exploratory baseline-adjusted models were used; missing outcomes were not imputed. Results: Carriers had lower six-month DAS28-CRP than non-carriers (2.53 ± 0.98 [n=10] vs 2.85 ± 0.99 [n=37]) and lower CRP (6.58 ± 6.96 vs 7.59 ± 9.29 mg/L). DAS28-CRP < 2.6 occurred in 60.0% of carriers and 35.1% of non-carriers (OR, 2.769; 95% CI, 0.660–11.618). High activity, recorded deformity, and biologic initiation were 10.0% vs 35.1%, 10.0% vs 29.8%, and 20.0% vs 36.1%, respectively. The composite score was 3.60 ± 1.08 vs 2.83 ± 1.07 (d=0.720; p=0.064). The adjusted DAS28-CRP coefficient was −0.165 (95% CI, −0.850 to 0.520; p=0.629). Conclusions: The carrier pattern suggests a more favorable short-term RA profile, but remains hypothesis-generating and requires prospective validation.