Objective: To investigate the diagnostic value of CT combined with erythrocyte sedimentation rate (ESR) and uric acid (UA) levels in gouty arthritis (GA). Methods: Clinical data of 86 suspected GA patients admitted to our hospital between January 2021 and December 2023 were retrospectively analysed. Based on joint aspirate microscopy results (gold standard), patients were categorised into GA group (n=52) and non-GA group (n=34). All patients underwent CT scanning, ESR measurement, and UA testing. The two groups were compared regarding CT imaging characteristics, ESR levels, and UA levels. The diagnostic efficacy (sensitivity, specificity, accuracy, positive predictive value, negative predictive value) of individual tests (CT, ESR, UA) versus combined testing (CT+ESR+UA) was analysed. Results: The GA group exhibited significantly higher rates of urate crystal detection, joint effusion detection, and bone destruction detection compared to the non-GA group, with significantly elevated ESR and UA levels (P<0.05). The combined diagnostic test demonstrated significantly higher sensitivity, specificity, and accuracy than CT alone, ESR alone, or UA alone (P<0.05). Conclusion: The combination of CT with ESR and UA significantly enhances diagnostic efficacy for GA, providing reliable evidence for its early clinical diagnosis.