Gout can present in a variety of less typical forms. We describe a case of an elderly woman presenting with hip and lower extremity pain. It remained undiagnosed for several days but proved to be secondary to gouty involvement of the right sacroiliac (SI) joint. Monosodium urate crystals were identified in computed tomographic guided aspiration of the SI joint. The importance of obtaining a good history and performing a complete physical examination if the diagnosis of sacroiliitis (or any other musculoskeletal disorder) is to be made, its cause defined, and proper treatment instituted is emphasized.