Well for what it's worth, I work for a Rheumy and he has his own u/s machine. I think out of all the tests, I like it the most as you see what's going on in real time. But he also orders x-rays and MRI's when needed. My x-rays were normal, yet the u/s scan was not. I think it just depends on each person as to what's going on individually. But every new patient can be assured they're getting labs and x-rays first and then maybe an ultrasound on their follow up visit.

I was officially diagnosed May 2011. At my intitial Rheumatologist visit, they did a series of X-Rays of the hands/fingers and feet/toes as part of the first visit routine. I have since been back to see him every 3 months as scheduled.

That was it - never any X-Rays or any type of imaging. And I do feel my case is fairly severe as my RA is bad enough to make me stop working 1.5 years ago.

So far x-rays and a nuclear bone scan, once each, over the last year and a half.

Unfortunately, only xrays...

My first rheumy had me get x-rays of hands and elbows, all of which showed damage. She also sent me for a chest x-ray before starting MTX. I saw her for 8 months, no additional imaging. The second one sent me for hand x-rays, which would have been 11 months after the first set. They showed additional damage, all of which he said was "subjective" and "meaningless". 5 months after that, I got in with my current one. I've been going to her for 10 months now. She ordered x-rays of my sacroiliac joints, and a new set of chest x-rays, nothing else. I just had an MRI of a messed-up shoulder, but that was ordered by an orthopedic surgeon.

How do they use them? The first one used them as part of her evidence to diagnose and commence treatment. The second must have used them to enhance revenue. The third one doesn't seem to use them much. As I'm getting appropriate, aggressive treatment, I guess that's OK?

The ultrasound I had last week when cortisone shots were given in the shoulder showed erosions. I am curious to see what the rheumy in the USA will say when I see him in a few weeks. So far he has only ordered x-rays, which largely appeared normal.
I don't want to get unnecessary imaging, but if results could help assess effectiveness of the current treatment, it might be worth it.

I had a nuclear bone scan while in India, when the rheumy there suspected the symptoms I was having was more than fibromyalgia. I believe the results sped up treatment.

Same here Melissa. I would not be on Plaquenil right now if I not for the nuke scan. My rheumy was skeptical, until then.