Abstract: Objective: To explore the correlation between high frequency ultrasound(HFUS) measurement parameters and the anti-rheumatic efficacy of early rheumatoid arthritis(RA), and the value of predicting the efficacy. Methods: A total of 97 cases of early RA patients admitted to Tongcheng People's Hospital of Anhui Province from March 2022 to March 2023 were selected as the study group, and another 97 cases of non-RA patients with at least one manifestation of arthritis in the same period were selected as the control group. The HFUS measurement parameters(synovial thickness, joint effusion, blood flow signal, bone erosion score), rheumatoid factor(RF), erythrocyte sedimentation rate(ESR), and C-reactive protein(CRP) levels were compared between the two groups. The correlation between HFUS measurement parameter score and ESR, RF, and CRP levels was analyzed. The study group was given anti-rheumatic treatment. The HFUS measurement parameter scores and changes of patients with different curative effects before treatment and after 3 months of treatment were compared, the correlation between the changes of HFUS measurement parameter score before and after treatment and the antirheumatic efficacy was analyzed, and the value of HFUS measurement parameter score before treatment in predicting the anti-rheumatic efficacy was analyzed. Results: The blood flow signal, synovial thickness, bone erosion, joint effusion score, ESR and serum RF, CRP levels in the study group were higher than those in the control group(P<0.05); in the study group, the blood flow signal, synovial thickness, bone erosion and joint effusion scores were positively correlated with RF, ESR and CRP levels(P<0.05); the synovial thickness, blood flow signal, joint effusion and bone erosion scores of patients with good curative effect before treatment and 3 months after treatment were lower than those of patients with poor curative effect, and the changes of each parameter score were greater than those of patients with poor curative effect(P<0.05); the AUC of anterior synovial thickness, blood flow signal, joint effusion and bone erosion score in predicting anti-rheumatic efficacy were 0.771, 0.742, 0.735 and 0.741, respectively, which had a certain predictive efficiency, and the AUC of combined prediction of each score was 0.921, which was greater than that of single prediction(z=2.316, 2.220, 2.887, 2.414, P=0.021, 0.026, 0.004, 0.016). Conclusion: HFUS measurement parameters can be used in the early diagnosis of RA and provide reference for early clinical evaluation of RA activity and anti-rheumatic efficacy, so as to carry out targeted follow-up intervention and improve prognosis.