We presented a case of a 44 year old female with hypothyroidism, T1DM, GERD who presented for worsening joint pain and swelling for 3 weeks. The joint pain and swelling is polyarticular and she has had severe fatigue and been bed-ridden for 2 weeks. She has had a rash on her face for several weeks that has come on and off for several years. No rash on hands, no pustules and no sick contacts. On exam she had swelling and tenderness over her right shoulder, right elbow and entire right hand as well as 2nd-5th MCPs, 2nd-5th PIPs and 3rd DIP as well as swelling and tenderness over her left knee and left ankle and tenderness to palpation of bilateral Achilles tendons. Her ESR was 91, her CRP was 15.3, and after extensive work up her uric acid was found to be 9.3. Join tap revealed yellow negatively bireferingent intracellular crystals and she was diagnosed with polyarticular gout. She was started on prednisone with good resolution of symptoms and she was eventually transitioned to colchicine.