Rheumatoid arthritis (RA) is an autoimmune inflammatory disease affecting multiple joints (mainly the wrists and small joints of the hand) with a prevalence of about 0.5–1.0%. We aimed to compare the effectiveness of US therapy in patients with RA combined with resistance exercise in RA patients compared with healthy control subjects. Methods: This randomized controlled, blinded, parallel group trial was conducted on 76 patients aged 18-75 years, suffered from RA and fulfilling the 2010 American College of Rheumatology classification criteria at the Physiotherapy Department. Cases were randomly divided equally into two groups; group A where patients received ultrasound associated with exercises and group B (control group). All patients were subjected to the clinical examination, laboratory investigations and RA-related characteristics including the presence of rheumatoid factor and anti-cyclic citrullinated protein antibody, disease activity was measured by 28 disease activity, erythrocyte sedimentation C reactive protein, and medications. All patients followed the same training program. Results: Regarding the radiographic joint damage, erosion score and joint space narrowing score after 3 months were significantly lower in group A compared to group B (P<0.001, 0.010). After 3 months, ultrasound total score and van der Heijde modified Sharp score were significantly lower in group A compared to group B (<0.001, 0.011). Conclusions: Our study highlights the importance of conducting randomized controlled trials to evaluate not only drugs but also new technologies or new treatment strategies. Ultrasound may have an important role in the diagnosis of rheumatoid arthritis and in procedures such as intra-articular injections