This review paper examines the limitations of X-ray techniques, and describes the results of the different methods of assessing disease progression including joint involvement in relation to the duration of the disease, and the different methods for scoring joint destruction. The application of the new X-ray technique of microfocal radiography, which produces radiographs of high magnification (x5-x10) and resolution (2 x 10(-5)m object diameter), is described. The techniques, developed by the author, provide the most accurate method of qualitative and quantitative assessment of disease progression in the wrist and hands of rheumatoid patients.