Nokea
A 35-year-old patient has been admitted to a hospital for pain in the left sternoclavicular and knee joints, lumbar area. The disease has an acute character and is accompanied by fever up to 38oC. Objectively: the left sternoclavicular and knee joints are swollen and painful. In blood: WBCs - 9, 5x109/l, ESR - 40 mm/h, CRP - 1,5 millimole/l, fibrinogen - 4,8 g/l, uric acid - 0,28 millimole/l. Examination of the urethra scrapings reveals chlamydia. What is the most likely diagnosis?
Correct Answer: A
Rationale: The most likely diagnosis is Reiter's syndrome. This is suggested by the presence of joint pain, fever, elevated ESR and CRP levels, and chlamydia infection. Reiter's syndrome is a reactive arthritis triggered by an infection elsewhere in the body, such as chlamydia. The patient's symptoms of joint pain and swelling, along with the positive chlamydia test, support this diagnosis. Rheumatic arthritis (Choice B) is not associated with chlamydia infection, making it less likely. Gout (Choice C) typically presents with elevated uric acid levels, which are normal in this case. Bechterew's disease (Choice D) primarily affects the spine and sacroiliac joints, not the sternoclavicular and knee joints as seen in this patient.