The combination which provided the best predictive value was a DAS28 > 3.2 and/or presence of active synovitis on PDUS and/or SEMA4A concentrations > 94 ng/mL (HR 10.42, 95% CI 1.41–76.94 for treatment failure and 4.88, 95% CI 1.50–15.89 for flares) (Fig. 3A,B). The gene discussed is SEMA4A; the disease is synovitis.