Background: Musculoskeletal ultrasound is available, noninvasive imaging technique with elevated patient acceptability. Gray scale ultrasonography (GSUS) is considered as more sensitive than clinical examination for detecting synovitis and more sensitive than conventional radiography for detecting bone erosions. Neutrophil/lymphocyte ratio (NLR) is defined as the proportion of absolute neutrophilic count to lymphocytic count measured from CBC that used for detection of inflammation in cardiovascular, ulcerative colitis and familial Mediterranean fever diseases.
Objectives: Evaluation of disease activity by the (NLR) and musculoskeletal ultrasound on early rheumatoid arthritis (RA) patients.
Patients and methods: A hospital_ based, cross-sectional research including 50 RA patients obtained from inpatients of the department of Rheumatology and Rehabilitation, Qena University Hospital. All participants were subjected for complete  history taking, complete general examination, complete musculoskeletal examination and investigations (CBC , ESR, CRP, RF, anti CCP), (N/L) ratio, Musculoskeletal ultrasound using (the US-7 score) and disease activity assessment using (DAS-28-ESR score)
Results: We found a significant positive correlation between disease activity of RA and NLR (r = 0.129 and p = 0.037) Also we detected a positive, powerful correlation between disease activity and each of the US-7 score (with Pearson Correlation coefficient of 0.704, 0.764, 0.590 & 0.829 for US-7 gray scale, US-7 Power Doppler, US-7 erosion and US-7 total scores; respectively) and p values of <0.001 for all of these scores.  
Conclusion: Musculoskeletal ultrasound was found to be more beneficial than Neutrophil/lymphocyte ratio as a provisional value in detection of disease activity among early RA patients.