Imaging has changed rheumatology practice in terms of both diagnostic approach and knowledge of disease mechanisms. Clinical symptoms, disease signs and the results of physical examination have been more closely related to their anatomical basis. In particular, ultrasonography (US), magnetic resonance imaging and videocapillaroscopy allow diagnosis of disease in its early phase. Novel imaging studies have contributed to elucidate several pathogenetic mechanisms in musculoskeletal diseases; allow evaluation of the real degree of joint inflammation, which is often uncoupled from clinical signs; and possibly reduce the need for large clinical trials. US-guided intra-articular and soft tissue injections nearly always reach the right target, improving the efficacy of the injection and avoiding several possible side-effects. Videocapillaroscopy allow differential diagnosis in Raynaud's phenomenon and may predict disease progression. In conclusion, new imaging techniques and refinements of the established techniques have opened exciting perspectives in our understanding and treatment of many rheumatic diseases.