Rheumatic immune diseases (RIDs) comprise a heterogeneous group of autoimmune disorders with intricate etiologies, diverse clinical presentations, and challenging diagnostic processes, necessitating additional diagnostic modalities. In recent years, musculoskeletal ultrasonography (MSUS) has been increasingly applied for the evaluation of RIDs and has gradually evolved into a routine auxiliary diagnostic technique. This review highlights recent reports on the utilization of MSUS in the diagnosis and management of patients with RIDs, with particular emphasis on rheumatoid arthritis, gouty arthritis, and osteoarthritis. Special attention was given to its clinical value in improving diagnostic accuracy, guiding therapeutic interventions, and predicting disease progression. The overarching aim was to standardize practices and facilitate the broader adoption of MSUS in routine rheumatology care.