Dr. Yogesh Singh Provides Radiology service at the department of radiology, Manipal hospital, old airport. Conventional radiography (both in its analogical and digital forms) is still the imaging modality of choice in assessing RA, being indispensable for all patients already at their first medical consultation, because radiographic changes are part of the diagnostic criteria for RA. In addition, the test is relatively inexpensive and almost universally available. However, the method is not sensitive to demonstrate the earliest changes of disease, mainly bone erosions; edema of the soft tissues and juxta-articular osteoporosis are some of the first radiographic findings. On radiography, the first sites affected are usually metacarpophalangeal joints (especially the second and third ones), metatarsophalangeal joints (especially the fifth), proximal interphalangeal joints, and ulnar and radial styloid processes.