Objective To study the MRI findings of patients with hand rheumatoid arthritis. Methods 93 patients with suspected hand rheumatoid arthritis who were admitted to the hospital from August 2015 to August 2017 were selected as subjects. All of them underwent clinical examination, laboratory examination and imaging examination. According to the results of 6 weeks of follow-up, the patients were divided into rheumatoid arthritis group and non-rheumatoid arthritis group. All patients underwent MRI scanning within 1 week of treatment. With follow-up results as the golden standard, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Kappa value of different MRI signs in the diagnosis of rheumatoid arthritis were calculated. Results Among the 93 patients with suspected rheumatoid arthritis, 85 cases were followed up till confirmed diagnosis and 71 cases were diagnosed as rheumatoid arthritis. The detection rates of synovial thickening, pannus enhancement, bone marrow edema, joint effusion and bone destruction in rheumatoid arthritis group were significantly higher than those in non-rheumatoid arthritis group (P<0.05). The sensitivity, specificity and accuracy of synovial thickening in the diagnosis of rheumatoid arthritis were 95.8%, 78.6% and 92.9%, respectively while those of pannus enhancement were 98.6%, 85.7% and 96.5%, respectively. The sensitivity, specificity and accuracy of bone marrow edema were 90.1%, 71.4% and 87.1%, respectively while those of joint effusion were 80.3%, 57.1% and 76.5%, respectively. The sensitivity, specificity and accuracy of bone destruction were 77.5%, 85.7%, 78.8%, respectively. Conclusion MRI can accurately reflect synovial thickening, pannus enhancement, bone marrow edema, joint effusion, bone destruction and other signs of hand rheumatoid arthritis, which provides important imaging evidence for the diagnosis and treatment of hand rheumatoid arthritis.