Despite the advances made in medical imaging over the past 3 decades and the central role that magnetic resonance imaging and other sophisticated technologies now play in routine clinical practice, patients with rheumatoid arthritis have benefited relatively little from these advances thus far. Over the past few years, however, evidence has accumulated to show that magnetic resonance imaging and ultrasonography can identify joint damage in patients with rheumatoid arthritis earlier and more sensitively than other techniques can, and that these techniques can directly visualize and monitor changes in synovium and bone that precede actual bone erosion. Much of this development is being driven by the pharmaceutical and biotechnology industries as they search for novel therapies to combat this disease. Accordingly, the imaging tools that ultimately will be used to direct patients to specific therapies and then to monitor treatment effectiveness and safety are currently being refined and validated in rigorous multicenter and multinational clinical trials aimed at gaining regulatory approval of these new therapies. As these therapies become available for clinical use, we can anticipate increased demand for expertise and experience in evaluating disease progression and treatment response, and to the emergence of magnetic resonance imaging systems specifically adapted for this application. The following discussion reviews the current status of this development, and notable advances that have been reported in the literature in the past year.