OBJECTIVE: To explore the effectiveness of contrast-enhanced ultrasound (CEUS) and high-frequency ultrasound (HFUS) in evaluating the efficacy of wrist intervention for rheumatoid arthritis (RA) patients. METHODS: This prospective study enrolled rheumatoid arthritis (RA) patients experiencing wrist swelling and pain at the Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, over the period from October 2021 to June 2024. All patients were given 1 mL of compound betamethasone injection under ultrasound guidance, and the characteristics of wrist synovium CEUS and HFUS before and after treatment were compared. RESULTS: A total of 49 patients (37 females, 53.45 ± 14.9 years) were enrolled. Peak intensity (PI) was highly correlated with the 28-joint disease activity score (r = 0.798, p <
0.01). The display rate of CEUS for synovium of wrist joints was 100% 2 weeks after treatment, while the display rate of PDUS for synovial blood flow was reduced to 65.31% (p <
0.05). Receiver operating characteristic curve analysis revealed that the CEUS had an area under the curve (AUC) of 0.792 (95% CI: 0.666-0.918, p <
0.002) in predicting the therapeutic effect, with sensitivity and specificity of 52.2% and 96.2%, respectively. Moreover, HFUS had an AUC of 0.722 (95% CI: 0.577-0.867, p = 0.008) in predicting the therapeutic effect, with sensitivity and specificity of 56.5% and 84.6%, respectively. CONCLUSION: CEUS and HFUS might be supplemental strategies in evaluating the therapeutic effect for RA patients.