To explore value of semi-quantitative scoring based on musculoskeletal ultrasound in diagnosis and disease assessment of gouty arthritis (GA). Ninety patients with suspected GA who received in our hospital from January 2022 to December 2023 were retrospectively selected as the study objects. The puncture results of joint synovial fluid or crystal material in the joint cavity were used as the gold standard, and the patients 'joint effusion, synovitis, bone erosion and tenosynovitis were counted. Compare the musculoskeletal ultrasound semi-quantitative score with the puncture results of joint synovial fluid or crystal material in the joint cavity to diagnose different pathological types of GA and evaluate the diagnostic efficiency of musculoskeletal ultrasound semi-quantitative score in diagnosing different pathological types of GA. Use correlation analysis to analyze the correlation between patients with the musculoskeletal ultrasound semi-quantitative score results, IL-6 and DAS28 scores, and typical musculoskeletal ultrasound and MRI examination results. There was no significant difference between the musculoskeletal ultrasound semi-quantitative score and the puncture results of joint synovial fluid or crystal material in the joint cavity. There was no significant difference between the examination results of different lesion types (P >
0.05). The puncture results of joint synovial fluid or crystal material in the joint cavity were used as the gold standard, the sensitivity of musculoskeletal ultrasound semi-quantitative scoring in diagnosing synovial thickening, joint effusion, bone erosion, and tendon/tendon sheath inflammation in GA patients was 92.86% (26/28), 96.00% (24/25), 95.24% (20/21), and 75.00% (12/16), respectively. The specificity values were 93.55% (58/62), 96.92% (63/65), 95.65% (66/69), and 98.65% (73/74) respectively. The accuracy rates were 93.33% (84/90), 96.67% (87/90), 95.56% (86/90), and 94.44% (85/90), respectively. According to Pearson linear correlation analysis, as the semi-quantitative scoring increased, there was a positive correlation with erythrocyte sedimentation rate, IL-6, and DAS28 scores (r = 0.729, 0.584, 0.773, P <
0.001). Observation of their serological indicators showed that there were significant differences in serological indicators between patients with different semi-quantitative scores (P <
0.05). Semi-quantitative scoring based on musculoskeletal ultrasound has high value in the diagnosis and assessment of gouty arthritis, and is worth further use.