Imaging has been used as an extension of clinical assessment in Medicine since radiography was developed and introduced over a century ago. Imaging methods allow us to see beyond the skin to enhance our knowledge of normal and abnormal anatomic structures and tissues. In the last decades, there has been a rapid technological development of new imaging modalities such as nuclear medicine imaging, computed tomography, magnetic resonance imaging, ultrasound and optical imaging that are applicable to rheumatology practice and research and have made education in imaging not only a necessity but also a challenge for our speciality. Presently, clinicians can accurately image musculoskeletal tissues involved in degenerative or inflammatory musculoskeletal diseases and other structures such as skin, nails, vessels and salivary glands that are involved in immune-mediated diseases in adults and children. Advances in imaging technology have enabled the routine use of imaging techniques to improve diagnosis and manage a wide spectrum of rheumatic and musculoskeletal diseases. Some imaging modalities have also been incorporated into clinical trials in rheumatic patients as valuable biomarkers and outcome tools that are complementary to conventional clinical and laboratory outcomes. The performance, diagnostic capability, applicability, feasibility, indications and limitations of each imaging modality is of paramount importance to optimize their use in different conditions in the clinical setting. Moreover, imaging techniques should demonstrate validity and reproducibility before their implementation in therapeutic clinical trials.

This issue offers an evidence-based update of the use and role of old and new imaging modalities in the most relevant rheumatologic diseases in clinical practice and research along with the key aspects of the research agenda in this field.