Background: Bone loss in rheumatoid arthritis (RA) is caused by increased bone resorption, however, there is no increased bone formation. The Wnt pathway is important in the control of bone formation through regulation of osteoblast activity. Sclerostin is an important regulator of the Wnt pathway by blocking Wnt binding to its receptor and thereby inhibiting bone formation. Aim of the work: This work aimed to study serum sclerostin level in a group of Egyptian rheumatoid arthritis patients and to correlate its level with bone mineral density, disease activity and radiological grading.Patients and methods: Forty patients (70% females and 30% males) diagnosed according to The 2010 American College of Rheumatology/ European League Against Rheumatism classification criteria for rheumatoid arthritis and 40 age and sex matched apparently healthy subjects were included. All patients were subjected to full history taking and clinical examination. Routine laboratory investigations and testing for serum sclerostin level were done. Plain radiographs of hands & feet and dual-energy x-ray absorptiometry test were done for all patients. Results: No significant difference was found between RA patients & healthy controls as regard mean value of serum sclerostin level. Postmenopausal women had higher levels of serum sclerostin than premenopausal , however, it was statistically significant on comparing healthy postmenopausal to healthy premenopausal only. Serum sclerostin had significantly positive correlations with age of RA onset and weight of RA patients and negative correlation with ESR in RA patients, but has no correlation with BMD disease activity or radiographic grading. Conclusion: Serum sclerostin level in RA patients did not differ significantly from healthy subjects. Serum sclerostin levels have no correlation to disease activity, radiographic joints damage or BMD in RA.