One hundred rheumatoid arthritis patients (38 men, 62 women), with mean age of 53 years and mean disease duration of 11.5 months, were followed. Standardized clinical, biochemical, and radiographic evaluation was performed regularly. After 2 years the prevalence of ulnar deviation, buttonhole deformity, and swan neck deformity was 13%, 16%, and 8%, respectively. Altogether, 31 patients had developed one or more deformities. There was no difference in age or gender distribution and no predominance of the dominant hand. Each patient with a deformity was matched according to age, sex, and disease duration with another early RA patient without deformity. The deformity group had more active disease, less grip strength, more disability, and markedly more severe radiographic changes. When studied retrospectively at a time point 3 months prior to the detection of deformity, synovitis of relevant joints was as common in the group who developed deformities as in the control group. This suggests that joint inflammation may contribute to the genesis of deformity but additional factors are needed. Hand deformities were found to be common in early RA.