The development of changes on X-rays in patients with rheumatoid arthritis (RA), as described in the literature, is presented. Prospective studies on patients with early disease show that approximately 75% of the patients have joint erosions. The majority of patients develop the first erosions during the first 2 yr of the disease. The rate of progression, expressed as newly eroded joints or increase in radiographic damage, is highest during the early years of the disease. Joints in the feet erode earlier than those in the hands. Moreover, more joints are affected in the feet than in the hands. Exact data on the involvement of large joints are scarce, but the progression of RA in small and large joints correlates well. Over half of the patients develop an involvement of the cervical spine during the first 10 yr of the disease. The percentage of patients with cervical subluxation increases steeply with disease duration.