Imaging studies are important adjuncts in the evaluation of children with suspected rheumatic diseases. They are best used as follow-up investigations to exclude specific differential diagnoses, based upon a careful history and physical examination. Often, repeated examination over a period of time, sometimes months, is necessary before a diagnosis can be made. The addition of selected imaging studies can be important in the common circumstance where no diagnosis is made, but the physician must assure the child and family that all appropriate efforts have been made to exclude important illnesses.