Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by marked clinical heterogeneity and the absence of a single diagnostic test. It most commonly affects young adults, mainly women, and typically involves the lungs and hilar lymph nodes, although extrapulmonary organ involvement is frequently observed. We present the case of a 39-year-old man with obesity (body mass index 33.25 kg/m²), arterial hypertension, and newly diagnosed type 2 diabetes mellitus, who was hospitalized due to pain and swelling of the ankle joints and the right wrist persisting for three weeks. Empirical outpatient antibiotic therapy failed to improve the patient’s condition. Laboratory findings revealed leukocytosis with neutrophilia, markedly elevated inflammatory markers, and metabolic abnormalities. Chest imaging demonstrated bilateral hilar and mediastinal lymphadenopathy as well as subpleural fibrotic changes in segment 9 of the right lung, raising suspicion of sarcoidosis. This case highlights the wide range of clinical manifestations of sarcoidosis, emphasising the importance of a thorough diagnostic evaluation. It highlights that sarcoidosis may present predominantly with joint involvement without typical cutaneous or respiratory manifestations. Coexisting metabolic disorders may further modify the inflammatory response and obscure the classic clinical presentation. Therefore, sarcoidosis should be considered in the differential diagnosis of arthritis of unclear etiology, particularly in patients with concomitant metabolic disturbances.