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Objective Handgrip strength (HGS) is a simple, non-invasive measure associated with disability, frailty and disease activity in chronic conditions such as rheumatoid arthritis (RA). However, longitudinal changes in HGS and their implications in RA remain underexplored. This study aimed to systematically review changes in HGS over time and its associations with disease status and follow-up duration in patients with RA.Design Systematic review and meta-analysis.Data sources A search of PUBMED, EMBASE and WEB OF SCIENCE were searched for cohort studies up to July 2025.Eligibility criteria Studies including RA patients, assessing HGS and employing an observational design.Results From 4301 studies (including 737 identified through citation tracking), 27 met the inclusion criteria, comprising 2742 individuals (mostly women (1784; 65.1%)), aged 19–87 years, with disease duration ranging from 2 months to 47 years. Participants generally had low to moderate disease activity and moderate to severe physical disability. Overall, HGS slightly increased over time (standardised mean difference; SMD 0.25; 95% CI 0.07 to 0.43). Greater improvements were observed in early RA (SMD 0.46; 95% CI 0.30 to 0.61), while no significant changes were found in established RA. HGS increased in patients followed for ≤1 year (SMD 0.25; 95% CI 0.07 to 0.43) and >1–5 years (SMD 0.43; 95% CI 0.05 to 0.81), but not beyond 5 years.Conclusion Patients with early RA tend to improve HGS over time, whereas those with longer disease duration show stable strength levels. HGS may serve as a useful marker for monitoring function and guiding personalised care in RA.PROSPERO registration number CRD42023473416.