Impact of imaging in established rheumatoid arthritis

Joint damage visualized on radiographs is still the hallmark of rheumatoid arthritis. With increasing duration of disease, there is an increasing relationship between joint damage and functional status. There are also other imaging techniques such as magnetic resonance imaging and ultrasound. The role of these techniques in clinical trials and clinical practice is discussed. Structural damage is an important measure of outcome for showing aspects of disease modification resulting from antirheumatic therapy. Recommendations are presented on how the results could be reported in an optimal way to ensure the correct presentation of data and comparability of the results. Joint damage is a clear sign of severe disease. More data become available that joint damage is related to several aspects of outcome, such as functional status, work disability and mortality. The significance and clinical implication of a certain magnitude of change in the modified Sharp score is discussed.