Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by the development of synovitis, which damages cartilage, bone, ligaments, and tendons. US is available, noninvasive, and relatively inexpensive bedside imaging method with high patient acceptability. This technique is more sensitive and reproducible than clinical evaluation in assessing joint inflammation. Power Doppler (PD) US detect flow from small vessels and low velocity flow at the microvascular level. PD US detects indirect signs of increased vascularization associated with soft tissue musculoskeletal inflammatory and infectious diseases and enteritis in spondyloarthropathies.
Aim of the work: Evaluating the correlation between the hand-swollen joints at a certain time-point and the subsequent structural deterioration using ultrasound.
Patients and Methods: longitudinal observational study included 30 Adult patients fulfilling 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism criteria will be included in this study.
Results: DAS, other paremeters of disease activity as ESR, CRP, swollen and tender joints is always positively and highly significantly correlated to disease severity both by total US gray scale count and total US PD score count at any time during follow up of our patients from start, after 6 months and after 12  
Conclusion: The combination of grey scale US and PD could be used as a sensitive and reliable non-invasive and widely available method complementary to standard clinical assessment for evaluating rheumatoid synovial inflammation in daily management and clinical trials.