Abstract Owing to the ability of musculoskeletal ultrasound (US) to depict cross sectional images of synovial joint and related structures, US has become the most reliable tool for evaluation of arthritic activity of rheumatoid arthritis (RA). US can detect early synovitis, assess disease activity, and determine true remission in patients with RA. US also can detect early enthesitis in patients with spondyloarthropathies. In addition, US can provide a reliable tool for measuring skin thickness in patients with systemic sclerosis. With guidance of injection or aspiration, US can result in a better clinical outcome. Thus, educational needs and research networks are increasing. We present a review of rheumatology US, focusing on recent trends and advances.