Background: Rheumatoid arthritis (RA) is a systemic autoimmune chronic inflammatory condition that may impact a variety of organs and tissues, but mostly targets flexible (synovial) joints. Objective: The aim of the current study was toassess influence of power Doppler ultrasound (PDUS) and high-resolution ultrasonography (US) in estimation of ankle joints abnormalities in patients suffering RA with or without ankle joint pain. Patients and methods: A cross sectional study was conducted on 100 participants presented with clinical diagnosis of RA, from the Rheumatology and Rehabilitation outpatient clinic of Al-Azhar University Hospitals. Participants were subjected to a comprehensive history, clinical examination by the referral to rheumatologist, laboratory tests, and high-resolution US and PDUS examination. Results: Patients with symptoms had a considerably higher Disease Activity Score in 28 joints (DAS 28) than those without symptoms (P<0.001). Patients without symptoms had a considerably greater prevalence of low DAS 28 scores (P<0.001), but high score was considerably greater in symptomatic individuals (P=0.007). Conclusion:US enables rapid identification and precise detection of joint and/or tendon inflammatory involvement at ankle level in individuals with RA. Clinicians should be recommended to utilize US more often to identify pathological ankle problems.