question: Q:A 25-year-old woman first presented to your clinic due to morning stiffness, symmetrical arthralgia in her wrist joints, and fatigue. She had a blood pressure of 132/74 mm Hg and heart rate of 84/min. Physical examination revealed tenderness to palpation of both wrists but full range of motion. Anti-citrullinated protein antibodies were positive and ESR was above normal ranges. She was started on methotrexate therapy. She returns for follow up 2 months later and is found to have megaloblastic anemia. What is the mechanism of action of methotrexate?? 
  {'A': 'Elevates tetrahydrofolate levels', 'B': 'Elevates methylmalonic acid levels', 'C': 'Intercalates into strands of DNA', 'D': 'Inhibits vitamin B12 activation', 'E': 'Inhibits dihydrofolate reductase'},