Features of aggressive, early rheumatoid arthritis, as seen in this x-ray of a 61-year-old woman with rheumatoid arthritis for 1 year, include evidence of soft-tissue swelling of the metacarpophalangeal and proximal interphalangeal joints, periarticular osteoporosis, symmetric joint space narrowing of several metacarpophalangeal and proximal interphalangeal joints of both hands, and subtle erosions of the right 3rd and right and left 4th metacarpophalangeal joints.