Objective High frequency ultrasound was used to evaluate the different ultrasonic manifestations of patients with gouty arthritis, to analyze the correlation between different ultrasonic manifestations and bone metabolism indexes, and to explore the role of muscle and bone ultrasound in the clinical diagnosis and disease monitoring of gouty arthritis. Methods The history and clinical data of 180 patients with gouty arthritis who were treated in rheumatology and Immunology Department of our hospital from June 2016 to August 2019 were analyzed retrospectively. According to the different manifestations of joint ultrasound, patients were divided into three groups: no aggregation group, aggregation group, and gouty stone group. The contents of CTX, oc-n-mid, DKK1 and RANKL were measured. The differences of bone metabolism indexes among the three groups were analyzed, as well as their correlation with clinical and laboratory indexes. Results There was no significant difference in CTX and oc-n-mid among the three groups, but there was statistical difference in DKK1 and RANKL. The content of gouty stone group was higher than that of aggregate group, while that of aggregate group was higher than that of non aggregate group. Pearson correlation analysis found that the longer the course of disease, the higher the serum uric acid level, the higher the serum DKK1 concentration, and the higher the RANKL content Conclusion Muscle bone ultrasound can detect the positive manifestations of gouty arthritis such as aggregation, double track sign, gouty stone and bone destruction. With the prolongation of the course of disease, the increase of bone destruction index indicates the aggravation of bone destruction, which indicates that muscle bone ultrasound can be used to evaluate the disease progress of patients with gouty arthritis, and combined with bone metabolism index can dynamically monitor the joint involvement of patients.