The major features of various global and detailed methods of assessment (scoring) of the hands and wrists of patients with rheumatoid arthritis are reviewed. Relative advantages and disadvantages of the methods are presented. Detailed radiographic scores relate best to other measures of patient status. Although scoring is not a difficult skill, the work is tiring, tedious, and time-consuming. Quantitative methods have done much to further our understanding of rheumatoid arthritis; they hold the promise of further discoveries.