The present study aimed to evaluate and classify sonographically the joint damage of the elbow in patients with rheumatoid arthritis. A grading of joint damage was developed, evaluated and compared with the radiographic standard reference films of the Larsen classification. A total of 30 patients were included in this study; 60elbows were examined in a prospective way. In 19 (63.3%) of the patients graded Larsen 0, sonography detected definite abnormalities classified as stage 1 to 4.Sonography is a valuable tool to assess and classify elbow joint alteration in rheumatoid arthritis. Particularly in early stages of joint affection, ultrasound is superior to X-ray in detecting soft tissue changes and minor erosions.