Gray scale ultrasonography enables direct visualization of synovitis, assessment of soft tissue disease, detection of fluid collection as well as visualization of cartilage and bone surface,. Color/power Doppler can be used to determine the presence and extent of inflammation.This study was performed to evaluate the role of high-resolution ultrasonography (HRUS) in the detection and quantification of the inflammatory changes that occur in the wrist in RA. Our study was conducted upon twenty-five adult patients with active RA according to the 1987 revised American Rheumatism Associated criteria (ACR), with disease duration ranging from 2 months to 20 years with a mean of 4.8 years ± 4.69 SD. Their ages ranged from 21 to 55 years, with a mean of 37.32 years ±10.33 SD. From our study we concluded that high-resolution ultrasonography (HRUS) is a reliable technique for the assessment of both soft tissue changes occurring in rheumatoid arthritis patients as well as destructive joint changes. It accurately detects synovial changes, finger tendon abnormalities and bone erosions.It is much better for the detection of pannus and effusion than clinical joint evaluation. HRUS is better in the depiction of bone erosions than the conventional radiography. The assessment of synovial pannus perfusion by the use of color/power Doppler techniques may prove to be an important objective in evaluating synovitis activity and differentiating between inactive and active pannus in rheumatoid joint.