Objectives: To determine serum levels of visfatin in rheumatoid arthritis (RA) patients and evaluate its predictability for disease severity as judged by radiological severity scores. Patients & Methods: The study included 70 patients; 41 patients had erosive lesions with a mean Larsen score of 32.1±7.3; range: 11-43 and 29 patients had mean Larson score of 7.3±1.3; range: 4-9. The study also included 20 cross-matched age and gender volunteers free of any form of joint affection as control group for laboratory data. All patients and controls gave blood samples for ELISA estimation of serum interleukin (IL)-6 and visfatin levels. Results: Estimated serum levels of IL-6 and visfatin in studied patients were significantly higher, both as total and categorized according to Larson score, compared to control group. Moreover estimated serum levels of IL-6 and visfatin were significantly higher in patients had radiological evidence of presence erosion compared to those free of erosion. There was positive significant correlation between presence of radiological evidence of bone erosion and patients' age, clinical data and disease severity scores and serum levels of IL-6 and visfatin and ROC curve analysis showed that all of them could predict presence of bone erosion specifically. Regression analysis for verification of these parameters showed that serum visfatin was significant predictor in 3 models, IL-6 in 2 models and DAS-28 score in only one model, thus indicating that visfatin could be used as specific significant predictor for RA severity. Conclusion: Serum visfatin level was elevated in RA patients and significantly correlated with severity scores. Regression analysis defined elevated serum visfatin as a specific predictor for erosion severity. However, wider scale studies are mandatory for evaluation of its prognostic value as a measure for remission and exacerbations of RA activity.