The ability to effectively treat patients with rheumatoid arthritis (RA) has become increasingly feasible with the use of powerful treatment regimens early on in the disease. The use of such regimens has, however, created a pressing requirement for better prognostic markers to allow the targeting of these treatments to those most at need, hence minimizing expense and toxicity. As the synovial membrane has been ever more recognised as the primary pathogenetic site in RA its role as a prognostic indicator has been explored. As yet no reliable single prognostic marker has been identified. This article discusses the range of pathological variables already examined and those markers holding most potential.