To evaluate the role of magnetic resonance imaging and ultrasonography of wrist and hand in diagnosis of rheumatoid arthritis.Patients and methods: Thirty patients with rheumatoid arthritis of wrist and hands as defined by The American College of Rheumatology/European League Against Rheumatism. All patients underwent ultrasonography and magnetic resonance imaging.Results: Magnetic resonance imaging (MRI) had the upper hand in evaluate all rheumatoid arthritis findings at early and established rheumatoid arthritis course (synovial thickening, increased vascularity, erosion and tendon abnormalities) and the bone marrow edema and bone cyst were detected only by magnetic resonance imaging, however ultrasonography (US) had high sensitivity, specificity and agreement with magnetic resonance imaging and even higher sensitivity in detection joint effusion. Both magnetic resonance imaging and ultrasonography had great role and comparable results in follow up and monitoring rheumatoid arthritis patients under anti-rheumatic drugs. By Chi-sqaure and P value, the synovial thickening and bone erosion was significant associated with increased vascularity by magnetic resonance imaging and ultrasonography but no association between synovial thickening and bone erosion. Bone erosion was highly associated with bone marrow edema.Conclusion: Ultrasonography findings of the hand and wrist joints in rheumatoid arthritis patients were comparable to magnetic resonance imaging findings which considered the gold standard for diagnosis.