Rheumatoid arthritis leads to many abnormalities in radiographs as a result of irreversible destruction of cartilage or underlying bone. Radiographs of hands and feet provide the most useful information. Erosions and joint space narrowing in particular can be assessed reliably, and give a good impression of the destruction of the joints. Several validated scoring methods are available to assess the severity and progression of joint damage. Abnormalities are already present shortly after onset of the disease. About 70% of the patients develop erosive disease and in the majority of the cases erosions are present one year after onset. Patients who are rheumatoid factor positive in particular develop erosions. Damage occurs earlier and is often more severe in the joints of the feet than in joints of the hands. The early occurrence of irreversible joint destruction and the availability of treatment effective in reducing this damage necessitates early treatment of patients with RA.