Background: Gout is a chronic heterogeneous disorder of urate metabolism results in deposition of monosodium urate crystals in the joints and soft tissues, with accompanying inflammation and degenerative consequences. Aim of work: Assessment of the role of musculoskeletal ultrasound (MSUS) in detecting changes in gouty arthritis patients under anti hyperuricimic treatment. Patients and methods: 30 patients with gouty arthritis treated with febuxostat 80 mg once daily for 3 months and 20 (age, sex & body mass index “BMI") matched controls were included. Patients were assessed by clinical examination, pain by visual analogue scale (VAS), tenderness by Ritchie index, functionally assessed using lower extremity functional scale & examination of joint effusion and tophi by palpation. MSUS findings in knee and first metatarsophalangeal “1st MTP" joints of patients and controls were reported before and 3 months after treatment. Results: BMI mean in patients group was 28.18 ± 1.49 (25-31) and in controls was 27.67 ± 1.56 (25-31). VAS, tenderness & lower extremity functional scale in patients before treatment in knee & 1 stMTP joints significantly improved after treatment (p < 0.001). There was a significant improvement in ESR, CRP, serum uric acid, double contour sign & knee effusion in patients after treatment compared to before treatment. Conclusion: Ultrasonography can detect changes related to treatment of gout with febuxostat. Febuxostat is a safe and efficient anti hyperurecemic drug and is effective in treatment of gouty arthritis. Ultrasound is more sensitive in detecting findings & changes of disease than clinical examination.