Thromboangiitis obliterans (TAO) is an uncommon to rare vasculitis of small and medium arteries and veins typically affecting young male smokers. Inflammatory arthritis has only been rarely reported in association with TAO. We describe the case of a young male smoker presenting with inflammatory arthritis as the initial manifestation of his TAO. His arthritis resolved with a course of corticosteroid therapy. The vascular disease improved with hyperbaric oxygen therapy, although he continued to smoke. Similar cases have been described, suggesting that rheumatologists should keep Buerger's disease in mind in patients with arthritis and vascular disease.