OBJECTIVE: To make recommendations for joint imaging in the management of rheumatoid arthritis (RA) based on evidence-based medical evidence. METHODS: The working group consisted of experts from 13 countries, including experts in rheumatology, imaging, and statistics. Evidence for the studies was drawn from the literature in MEDLINE, EMBASE, and the Cochrane database. The working group experts made ten recommendations based on the evidence from the relevant studies and assessed the strength of the recommendations using VAS scores. RESULTS: The 10 recommendations covered diagnosis of RA, determination of joint inflammation and destruction, prognostic assessment, and response to treatment, and included a full range of monitoring for disease activity, RA progression, and remission. The details are as follows: Recommendation 1: When RA is suspected, RA diagnostic criteria combined with radiographs, ultrasound and MRI can improve diagnostic reliability over RA diagnostic criteria alone. Strength of recommendation: 9.1 (95% CI 8.6-9.6). Recommendation 2: Prediction of progression of undifferentiated inflammatory arthritis to RA based on whether inflammation is detected by ultrasound and MRI. strength of recommendation: 7.9 (95% CI 6.7-9.0). Recommendation 3: Ultrasound and MRI provide a more accurate assessment to determine joint inflammation and are superior to clinical physical examination. Strength of recommendation: 8.7 (95% CI 7.8-9.7). Recommendation 4: X-rays are the preferred test for detecting joint destruction, but ultrasound and/or MRI can detect early joint destruction in RA (especially for early RA) if joint destruction is not detected on X-rays. Recommended intensity: 9.0 (95% CI 8.4-9.6). Recommendation 5: Bone marrow edema detected by MRI is an independent risk factor for early RA imaging progression and may be used as a predictor. joint inflammation (synovitis) detected by MRI and ultrasound and joint destruction detected by radiographs, MRI and ultrasound may predict further joint destruction. Strength of recommendation: 8.4 (95% CI 7.7-9.2). Recommendation 6: Joint inflammation detected by imaging is a better predictor of treatment response than clinical disease activity, so imaging can be used for treatment response prediction. Strength of recommendation: 7.8 (95% CI 6.7-8.8). Recommendation 7: Because ultrasound and MRI are more sensitive than clinical physical examination in detecting joint inflammation, these imaging tests can be used to monitor disease activity. Strength of recommendation: 8.3 (95% CI 7.4-9.1). Recommendation 8: Radiographs of the hand and foot can be used for periodic assessment of joint destruction, whereas MRI (and ultrasound) are more sensitive in detecting joint destruction and can be used to monitor disease progression. Recommended intensity: 7.8 (95% CI 6.8-8.9). Recommendation 9: When RA is suspected to involve the cervical spine, cervical orthogonal and flexion lateral radiographs should be performed. MRI should be refined when radiographs are abnormal or when there are positive specific neurological signs/symptoms. Strength of recommendation: 9.4 (95% CI 8.9-9.8). Recommendation 10: Ultrasound and MRI can be used to assess persistent joint inflammation, as they can detect joint inflammation even in clinical remission of RA and predict further joint destruction. Strength of recommendation: 8.8 (95% CI 8.0-9.6).