Early diagnosis is essential for the optimal treatment of rheumatoid arthritis (RA). Conventional X-rays only visualize the late signs of the disease outcome. There are evidences that magnetic resonance imaging (MRI) and musculoskeletal ultrasonography (MSUS) are sensitive in detection of early inflammatory and destructive changes in RA. OBJECTIVE: This study was performed to compare the effectiveness of MSUS with MRI in early detection of hands and feet joints involvement in early RA. SUBJECT and METHODS: Forty patients with early RA (less than 12 months disease duration and no visible erosion in their conventional X-ray) were subjected to a detailed MSUS examination in a minimum of two planes (longitudinal and transverse) of both hands and feet joints. Eighty radio-carpal, 320 MCPs (excluding the 1st MCPs), 400 PIPs, 80 ankles, and 400 MTPs joints were examined for the presence of synovial thickening, effusion and erosions on initial evaluation and after 6 months. MRI examination of the hands and feet was arranged to be done at the same appointment of MSUS examination.