The Evolving Role of Musculoskeletal Ultrasound in Gout

Gout, a prevalent and treatable form of crystal-induced arthritis, results from monosodium urate (MSU) crystal deposition in articular and periarticular tissues. Early diagnosis is crucial to prevent progression to chronic gouty arthritis, tophus formation, and structural joint damage. Musculoskeletal ultrasound (MUS) has emerged as a sensitive, noninvasive, and cost-effective imaging modality that enables the visualization of urate crystal deposition, evaluation of treatment response, and prediction of disease flares. This narrative review summarizes recent advances in MUS for the diagnosis and management of gout, including its integration into the 2015 ACR/EULAR classification criteria and the development of OMERACT consensus-based definitions and semi-quantitative scoring systems. Compared with dual-energy computed tomography (DECT), MUS is more accessible and radiation-free, and offers superior performance in detecting early-stage gout. MUS also provides valuable insights into comorbidities such as cardiovascular disease and chronic kidney disease. Furthermore, emerging technologies-such as superb microvascular imaging (SMI) and artificial intelligence (AI)-based deep learning-show promise in enhancing diagnostic accuracy and automation. MUS is expected to play an increasingly pivotal role in the comprehensive management of gout.