Background: Joint damage, disease activity, and prognosis in rheumatoid arthritis can now be evaluated by shear-wave elastographic ultrasonography (SW-EUS). Objective: Evaluate of the role of musculoskeletal ultrasound in early diagnosis of rheumatoid arthritis and monitoring treatment, as well as evaluating the added value of using Elastography. Patients and methods: A case-control study that included 30 rheumatoid arthritis patients and 30 controls have same age and sex of chronic cases; we did shear wave elastography ultrasound (SW-EUS) image obtained for all subjects. Results: Statistically significant differences were found in SWE parameters, as well as between recently diagnosed RA patients and after 2 months follow up between RA patients and healthy control where the mean of Elastic Modulus (KPa) that was statistically lower among RA patient than among healthy control. Also, the mean of Elastic Modulus (KPa) increased from 15.67 ± 10.56 to 42.07 ± 17.8. Additionally, mean of Mean Velocity (m/sec) increased from 2.19 ± 0.63 to 3.47 ± 0.91 that was statistically higher after 2 months. An Elastic Modulus (KPa) Cut-off level of Elastic Modulus (KPa) < 44.35 had sensitivity of 100 %, and specificity of 94 % in detecting RA changes. Also, Cutoff level of Mean Velocity (m/sec) < 3.76 had sensitivity of 100 %, and specificity of 93.3 % in detecting RA changes of high statistical significance. Conclusion: Diagnosing and assessment of disease activity in RA can be evaluated with SW-EUS.