In this radiological study, bilateral radiographs of the wrist in 48 patients with early rheumatoid arthritis (RA) were graded by the Simmen classification, at different times, to determine its potential use in early disease. Interobserver agreement was good. The Simmen classification of wrist destruction in RA could be applied to the radiographs of approximately 50% of patients with early disease. It has some consistency over time.