An arthritis caused by deposition of uric acid crystals primarily in the big toe, midfoot, ankle, knee, or wrist is extremely painful, associated with redness, swelling, and pain in the joint to the point that a “bed sheet can’t touch it”. Commonly erupting in the middle of the night, it is associated with hypertension, diabetes, abnormal cholesterol, and metabolic syndrome. Alcohol intake and diuretics (fluid pills) typically make it worse, and it usually cannot be controlled by diet. Treatment includes lifestyle modifications, changes in blood pressure medications, and use of Colcrys, Allopurinol, or Uloric to lower acid levels in the blood. Occasionally more aggressive therapy is required.