Background: Rheumatoid arthritis disease is a chronic inflammatory disease, character­ized by development of synovitis, which damages cartilage, bone, ligaments and tendons. High resolution ultrasound has become an established imaging technique for the diagnosis and follow-up of patients with rheumatoid arthritis Objective: The study was conducted on early symptomatic cases of Rheumatoid Arthritis that referred to Radiology out clinic in Qena General Hospital, to evaluate the role of gray scale ultrasound and power Doppler in the diagnosis. Patients and methods: The total numberwas30 patients, 25 females and 5 males suffering from rheumatoid arthritis. Patients examined by GE LOGIQ P5 ultrasound machine using a near focused linear array transducer with color Doppler and by Plain X ray radiographs. Results: Results showed the following: Synovial thickening was detected in 22 patients (73%), active synovitis was detected by Doppler US in 13 patients (43%),
 Effusion was detected in 15 patients (50 %), and Bone erosions were detected in 5 patients (17%) and X-ray finding was detected in 4 patients (13 %). Conclusion: HRUS with PD is an efficient technique to assessment of (RA) patient and evaluation of vascularity, differentiate between inactive and active synovial hypertrophy and has the potential role in diagnosis, assessment and follow up of the patients with RA therapy.