We evaluated methods of grading radiologic progression of osteoarthritis (OA). Sets of radiographs were assessed separately by 8 readers who were blinded to the time sequence. Included were radiographs of patients with OA of the hands (24 pairs), hips (40 pairs), and knees (32 pairs). Most films were taken 1240 months apart. The relative contribution of individual joints (such as particular interphalangeal joints), of observations (such as narrowing or spurs), and of a single joint compartment (such as the medial or lateral compartment of the knee) toward evidence of OA progression Submitted for publication September 30, 1986; accepted in revised form April 9, 1987. was evaluated, as well as the reliability and concordance of scoring, and the sensitivity in detecting change. In assessing OA of the hand, the greatest sensitivity was achieved by reading a single posteroanterior bilateral hand radiograph for narrowing, spurs, and erosions, and scoring 10 joints (second and third distal interphalangeal, second and third proximal interphalangeal, and trapeziometacarpal joints, bilaterally), using a scale of 0-3. In OA of the hip, a single anteroposterior radiograph assessed for joint space narrowing and cyst formation yielded the greatest sensitivity. In OA of the knee, an anteroposterior radiograph, with weight-bearing, assessed for narrowing, spurs, and sclerosis in both the medial and lateral compartments yielded the greatest sensitivity. These techniques will be useful to the investigator in designing experimental studies and to the clinician in determining the rate of disease progression in an individual patient.Standards for the radiographic identification of osteoarthritis (OA) were established by Kellgren and Lawrence in 1957 (1) and were accepted by the World Health Organization in 1961 (2). In several recent descriptions of the radiographic appearance of OA, clinical and pathologic correlations have been used to help differentiate OA from normal states and from other disease entities (3-6). However, there are no methods presently available to assess radiographic progression of OA by use of serial radiographs.Radiographs are frequently used in clinical trials of OA to establish inclusion criteria. However, such trials have not used radiographs to assess disease progression. The consistency of OA progression is not known. The reasons for not utilizing radiographs to evaluate progression in long-term trials are, perhaps,