Joint pain is the main symptom of acute attacks in patients with gout, which if not managed properly, can develop into chronic gout. The aim of this study was to investigate the correlation between ultrasound (US) features of gouty arthritis (GA) and its clinical manifestations to provide a basis for diagnosing and evaluating the disease.We retrospectively analyzed 182 sites in 139 patients with GA diagnosed by the Rheumatology and Immunology Department. Degree of pain was evaluated using the visual analog scale (VAS). Patients with GA were divided into active and inactive arthritis groups. Statistical differences between the two groups and the correlation between US features and clinical manifestations of the affected joints in patients with GA were analyzed.The groups had statistical significance in joint effusion, power Doppler ultrasonography (PDS), double contour sign, and bone erosion (p = 0.02, 0.001, 0.04, 0.04, respectively). Correlation analysis in this study showed that joint effusion and PDS were positively correlated with degree of pain (r s = 0.275, 0.269; p < 0.001, <0.001, respectively). Additionally, PDS was positively correlated with synovitis, joint effusion, bone erosion, and aggregates (r s = 0.271, 0.281, 0.222, 0.281; p < 0.001, <0.001, 0.003, <0.001, respectively).Pathological US features, such as joint effusion, synovitis, PDS and bone erosion were more likely to be detected in GA with clinical signs and symptoms. PDS was positively correlated with joint effusion and synovitis, pain was closely related to PDS and joint effusion, which suggested that the clinical symptoms of GA were related to inflammation, reflecting the patient's condition to some extent. Therefore, musculoskeletal US is a useful clinical tool for managing patients with GA and can provide a reliable reference for diagnosing and treating GA.© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.