Efficient methods for diagnosis, monitoring and prognostication are essential in early rheumatoid arthritis (RA). While conventional X-rays only visualize the late signs of preceding disease activity, there is evidence for magnetic resonance imaging (MRI) and ultrasonography being highly sensitive for early inflammatory and destructive changes in RA joints, and for MRI findings being sensitive to change and of predictive value for future progressive X-ray damage. Reviewing the data on X-ray, computed tomography, MRI and ultrasonography in RA, this paper discusses current and future roles of these imaging modalities in the management of early RA. The main focus is on recent advances in MRI and ultrasonography. Suggestions on clinical use and research priorities are provided.