The grading evaluation of metacarpophalangeal rheumatoid arthritis (RA) ultrasonic images is a diagnostic challenge that heavily relies on the expertise of trained sonographers. This project propose a grading method for detecting and estimating the geometric and texture features of synovium thickening and bone erosion. Unlike previous studies in this area, this project uses the metrics and texture features of region of interest (ROI). The highlighted feature of metacarpophalangeal bone and the dark feature of the synovial thickening are extracted simultaneously by the segmented method based on the Gaussian scale space. The segmented results are analyzed to extract three quantitative geometric parameters, which are combined with gray-level co-occurrence matrix (GLCM) statistic texture features to describe the ultrasonic image of metacarpophalangeal RA. To obtain the preferable ability of classification, we applied a support vector machine (SVM) and various feature descriptors, including GLCM, local binary patterns (LBP), and GLCM C LBP, to grade the ultrasonic image of metacarpophalangeal RA. Results show that the SVM, based on our feature descriptor, provides the highest accuracy of up to 92.50%, of the four descriptors. The SVM based on GLCMCLBP descriptor shows better accuracy (86.55%) than either SVM C LBP (85.43%) or SVMCGLCM (82.51%) for discriminating among four grade RA ultrasonic images. Overall, this methodology points to a significant grading of metacarpophalangeal RA ultrasound images without medical expert analysis or blood sample analysis, such as detecting C-reactive protein, measuring erythrocyte sedimentation rate, and testing rheumatoid factor. This project is implemented with MATLAB software.