Assessment of radiographic abnormalities in rheumatoid arthritis: what have we accomplished and where should we go from here?

Assessment of radiographic damage in rheumatoid arthritis (RA) by scoring methods is useful to describe the progression of disease, and is an objective method of determining the effects of treatment. The history of the development of radiographic scoring methods is reviewed. None is ideal or truly quantitative and better methods are needed. Features of an ideal method are presented and the results of assessing treatment of RA by current methods of radiographic scoring are reviewed. Suggestions are made regarding the design of future therapeutic trials to take advantage of study features most likely to yield conclusive results by radiographic outcome assessment.