Objective To explore the clinical diagnostic value of X-ray in patients with gouty arthritis.Methods A total of 80 patients with gouty arthritis admitted to our hospital from November 2017 to November 2019 were selected as the observation subjects.All patients underwent X-ray and computed tomography (CT) examinations.The detection rate of gout nodules, bone defects, joint changes, soft tissue swelling, subchondral cystic changes, soft tissue calcification using the two methods was compared.X-ray performance of early gouty arthritis, mid-term gouty arthritis, late gouty arthritis was analyzed.Results The detection rates of X-ray examination for gout nodules, bone defects, joint changes,soft tissue swelling, subchondral cystic changes, and soft tissue calcification were 60.00%, 85.00%, 78.75%, 73.75%,66.25%, and 82.50% respectively.The CT detection rates of gout nodules, bone defects, joint changes, soft tissue swelling, subchondral cystic changes, and soft tissue calcification were 61.25%, 87.50%, 81.25%, 75.00%, 68.75%, and 83.75% respectively, there were no statistical differences in these data using the two methods (P＞0.05).There were no significant differences in the accuracy, sensitivity and specificity between X-ray and CT examinations (P＞0.05).The average cost of X-ray examination was (76.28±7.46) yuan, and which was (233.61±21.55) yuan in CT examination, with statistical difference (P＜0.05).By X-ray detection, 36 patients with early gouty arthritis manifested as a clearly defined oval or fusiform soft tissue shadow at the affected joint, which was a reversible change.A total of 27 patients with midterm gouty arthritis manifested as nodular uplift in asymmetric soft tissue adjacent to the joint, irregular depression and lobulated shape occurred adjacent to the bone, the edge of the bone appearing as a spur-like lifting of the eggshell,and urate deposited in the articular cartilage which showed a chisel-like cystic destruction after bone erosion.A total of 17 patients with late gouty arthritis manifested as a remarkable enlargement trend in the eccentric soft tissue mass,severe damage on the bone, and linear hardening, quasi-circular holes, severe collapse of the joint surface, and narrowing of the joint surface in the edge of the bone.Conclusion Patients with gouty arthritis undergoing X-ray examination have a high detection rate and is sensitive, and the examination cost is low, with good imaging performance.