SummaryFor the first time, the new ACR/EULAR gout classification criteria incorporate ultrasound (US) evidence of double contour sign (DC), an articular cartilage abnormality related to the deposition of crystals on the surface of the hyaline cartilage, as a sign specific to gout. US recently has been used as an objective diagnostic tool for detecting urate deposition (tophus (T), DC) or joint damage (erosion) in gout. Objective: Our aim was to investigate the relationship between clinical gout activity and load of US changes, also to examine the concordance between patient reported joint attack (PRGA) and ultrasonographic intraarticular changes. Methods: Sixty monosodium-urate-crystal-confirmed gout patients and 36 healthy controls were prospectively included in one centre. The relationship between clinical symptoms and ultrasonographic gout-related changes investigating 36 joints and 4 tendons (m. triceps and patellar) was evaluated using Spearman's correlation and agreement analysis (kappa coefficient). Results: moderate, positive correlation was observed between the number of subcutaneous tophi and total US tophus area (rs=0,628), total number of DC (rs=0,612), and erosions (rs=0,526), all p<0, 0001, found per patient on US. Gout attacks and disease duration significantly positively correlated with the load of all investigated US changes (p<0, 01).