〔Abstract〕 Objective To compare the ultrasound signs of symptomatic joint lesions in rheumatoid arthritis(RA) and gouty arthritis(GA), musculoskeletal ultrasound(MSUS) was utilized. Methods A retrospective analysis was performed for 85 hospitalized patients with RA and 55 hospitalized patients with GA in the same period, and the differences in general data, diseased joints and ultrasound signs between the two groups were compared. Results The gender, age and diseased joints of the two groups were statistically significant(allP<0.05). The detection rate of knee joint lesions was the highest; the RA group had high sensitivity, high specificity of meniscal injury, and high diagnostic efficiency of bone erosion, while the diagnostic performance of the three combined ultrasound signs of punctate strong echo, double track sign and tophi in the GA group was higher than that of any individual diagnosis, and the sensitivity and specificity were also higher. The course of disease in the RA group was positively correlated with bone erosion(P<0.05), and the course in the GA group was positively correlated with tophi(P<0.05). Conclusion The ultrasound signs of RA and GA are different, and MSUS has good value in the diagnosis and differential diagnosis of the two.