Objective To analyze the value of musculoskeletal ultrasound in the diagnosis of gouty arthritis (GA). MethodsA total of 45 patients with GA were selected as the study group, 45 patients with rheumatoid arthritis as the control group, and musculoskeletal ultrasound was performed in both groups. The musculoskeletal ultrasound examination manifestations and involved joints numbers were compared between the two groups, as well as the sensitivities and specificities of musculoskeletal ultrasound manifestations in the diagnosis of GA . Results The musculoskeletal ultrasound examination manifestations in the study group showed more tophi, hyperechoic point, intraligament hyperecho, and bilateral signs, while tenosynovitis was more common in the control group, and the differences in the positive numbers of musculoskeletal ultrasound examination manifestations between the two groups were statistically significant (all P<0.05). The study group had a total of 46 joints involved, the control group had 40, and there was no statistically significant difference in the number of various types of joints involved between the two groups (P>0.05). The sensitivity and specificity of musculoskeletal ultrasound manifestation of tenosynovitis, tophi, hyperechoic point, intraligament hyperecho, and bilateral signs for diagnosing GA were 64.44%, 73.33%, 37.78%, 20.00%, 88.89%, and 15.56%, 51.11%, 86.67%, 97.78%, 73.33%, respectively. Conclusion In the diagnose of GA, musculoskeletal ultrasound has certain value, and some manifestations have high sensitivities and specificities.