Systemic rheumatic diseases frequently pose diagnostic challenges to the clinician. The precise nature of the disorder can be obscure and different disorders can present with similar symptoms, such as joint pain. Plain radiographs provide an appropriate starting point for detection of joint abnormalities. Musculoskeletal ultrasound and MRI offer greater sensitivity in detecting synovitis, tenosynovitis and bony erosions, among other features. However, due to the rarity of these diseases and lack of prospective longitudinal trials, a broader picture of the epidemiology of these findings and their implications for treatment and outcomes remains to be determined.