Rheumatoid arthritis may begin in the small joints of the hands and feet and is most likely to occur in the metacarpophalangeal, metacarpophalangeal, and proximal interphalangeal joints. It should also be noted that the distal interphalangeal joints, the 5th proximal interphalangeal joint, the 1st metacarpophalangeal joint, and the 1st metatarsophalangeal joint of the hand and foot are not typical sites of rheumatoid arthritis. Degenerative arthropathy occurs in the distal interphalangeal joints and the 1st metacarpophalangeal joint, but can also occur in other small joints of the hands and feet. Rheumatoid arthritis is often symmetric, whereas degenerative arthropathy is often asymmetric. Rheumatoid arthritis is characterized by bone sparing and superficial destruction of the articular surface, often more pronounced on the ulnar side when it occurs in the hand, and earlier changes in the ulnar styloid process in the wrist joint, often invading the navicular bone and small polygonal bones. Periosteal hyperplasia can occur at the attachment of the joint capsule, commonly in the foot. When degenerative arthropathy occurs in the hands and feet, there are no early radiographic manifestations, and later osteophytes are often seen at the base edge of small tubular bones, and sclerosis and cystic changes of the articular surface are visible. Sometimes small bones can be seen next to the joint as a result of soft tissue ossification. These small bones are called Heberden’s knots when they occur in distal interphalangeal joints and Bouchard’s knots when they occur in proximal interphalangeal joints.