Summary Rheumatoid arthritis is a chronic disease with episodes of exacerbation and remission. The natural history in any patient may be unpredictable, and because of this it is often difficult to establish rational therapeutic goals. We have found it helpful to classify rheumatoid hand involvement into four stages in order to establish a rational plan for treatment. This discussion describes the four stages and discusses the evaluation of the patients in stage 1 with early rheumatoid involvement. In addition, the nonsurgical forms of treatment for the patient with early involvement are described. These include splinting, steroid injections, rest and exercise, and psychologic support.