Fig. 1

A 45-year-old woman with known rheumatoid arthritis, complaining of recurrence of mild symptoms after reduction of methotrexate medication. Radiographs of the hands were normal (shown here X-ray left hand, a). Ultrasound demonstrates a bone erosion of the second metacarpal head with mild hypervascularity (b), indicating active mild inflammation. Ultrasound is far more sensitive than radiography for inflammatory joint change