Background: Rheumatoid arthritis (RA) is a chronic, immune-mediated inflammatory disease affecting the synovial joints, including the elbows, leading to significant joint damage and decreased quality of life. Objectives: This study evaluates the frequency of elbow joint involvement in RA patients and its impact on disease activity and quality of life. Methods: This cross-sectional study included 35 RA patients and 35 healthy controls recruited from Benha University Hospitals. Patients were classified as having RA according to the ACR/EULAR 2010 criteria RA was diagnosed using the ACR/EULAR 2010 criteria. All patients underwent clinical evaluation, ultrasound examination, and assessment of disease activity (DAS28) and quality of life (SF-36). Results: Right elbow involvement was observed in 63% of patients, with tenderness (97%) and flexion deformity (46%) being the most common clinical signs. Inflammatory markers, including ESR (mean 48.69 ± 25.61 mm/hr) and CRP (mean 18.5 ± 18.8 mg/dL), were elevated, and hemoglobin was reduced (mean 10.6 ± 1.6 g/dL). Ultrasound revealed synovitis in 63%, effusion in 80%, and Doppler signal in 66% of patients. DAS28 scores were higher in RA patients (4.61 ± 0.72, p < 0.001) compared to controls. All SF-36 domain scores, including physical functioning (p < 0.001) and mental health (p < 0.001), were lower in RA patients. Conclusions: RA frequently affects the elbow joints, with associated high disease activity and reduced quality of life. Ultrasound is a valuable tool for detecting elbow involvement in RA, and elevated inflammatory markers correlate with greater disease severity and poorer quality of life.