Aim of the work: to study the ultrasonographic (US) features of the knee joints in a cohort of confirmed and high risk gouty arthritis patients, to assess their value in diagnosis and their relation to clinical characteristics. Patients and methods: The multi-centre study included 425 patients with gouty arthritis presenting to one of 12 specialized rheumatology centers across the country. Participants had either mono- or oligo-arthritis with effusion of the knee or the first metatarsophalangeal joint. Results: The mean age of the patients was 54.2 ± 10.3 years and disease duration 4.4 ± 4.3 years. They were 267 males and 158 females (M:F 1.7:1). 53.4% were from urban areas and 46.6% rural. 85.9% of the patients had oligoarthritis (monoarthritis in 16.1%). Knees were involved in 82.1% (68.1% unilateral and 14% bilateral). The diagnosis of gouty arthritis was confirmed in 86.6% of cases. Males had a higher number of joints involved (3.5 ± 3.3 vs 2.8 ± 1.3; p = 0.006) and imaging evidence of gout-related damage (0.56 ± 1.4 vs 0.07 ± 0.54; p