Several musculoskeletal ultrasound scoring methods exist to monitor rheumatoid arthritis disease activity and the therapeutic response to immunosuppressive therapies. Qualitative (0/1) and different semiquantitative (0–-3) systems as well as quantitative measurements are used. The semiquantitative 4-grade system developed by Szkudlarek et al., which evaluates joint effusion, synovial thickening, bone erosion and power Doppler activity, is mostly applied. Thus far, an internationally accepted US sum scoring system does not exist. The novel seven-joint ultrasound (US7) score is the first US composite scoring system that combines soft tissue lesions (synovitis and tenosynovitis/paratenonitis) and destructive processes (erosions) in a single scoring system. By that, the implementation of the US7 score can quickly and easily give an overview of current disease activity in daily rheumatologic practice. Furthermore, its use in therapy monitoring is very helpful. This article reviews the development of different US scores and sum-scoring systems in a chronological order and contains current and future activities in this field.