A 42-year-old female patient came with complaints of worsening pain in the big toe joint and ankle over the past 10 days. She denies any recent injury or accident. She has a medical history of hypertension and is managed by Losartan 50 mg. The patient has a significant family history of rheumatoid arthritis. She denies smoking but often consumes alcohol twice weekly. On examination, the vitals include blood pressure of 135/90 mmHg, pulse rate of 86 bpm, respiratory rate of 20 breaths per minute, normal heart sounds, a body temperature of 98.6°F, and BMI of 40kg/m2. Palpation revealed warmth, swelling, and tenderness of the right big toe joint. Laboratory investigations revealed increased WBCs, ESR, C-reactive protein, and serum urate levels. A positive double contour sign was revealed on ultrasound, as exhibited in the image.