question: Q:A 55-year-old woman presents to the office complaining of leg ulcers for the past 6 months. She has a chronic history of severe rheumatoid arthritis controlled with methotrexate. She does not drink alcohol or smoke cigarettes. Her vitals are normal. Her lungs are clear to auscultation. The abdomen is soft and non-tender with a palpable spleen tip on inspiration. Skin examination shows scattered ulcers on the legs in various stages of healing. Additionally, metacarpophalangeal and proximal interphalangeal joints are tender. Varicose veins are not observed. Laboratory results are as follows:
  Hemoglobin  10.5 g/dL
  MCV 74 fl
  Platelets 226,000/mm3
  White blood cells 2500 /mm3
  Neutrophils 20%
  Alanine 36/UL
  Aminotransaminase aspartate 39/UL
  Aminotransaminase creatinine 1.0 mg/dL
  HIV test is negative. Which of the following is the most likely cause of this patient’s condition?? 
  {'A': 'Venous stasis and valve insufficiency', 'B': 'Felty syndrome', 'C': 'Drug toxicity', 'D': 'Vitamin deficiency', 'E': 'Caplan syndrome'},