<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .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 gdLMCV 74 flPlatelets 226,000mm3White blood cells 2500 mm3Neutrophils 20Alanine 36ULAminotransaminase aspartate 39ULAminotransaminase creatinine 1.0 mgdLHIV test is negative. Which of the following is the most likely cause of this patients condition?? A: Venous stasis and valve insufficiency, B: Felty syndrome, C: Drug toxicity, D: Vitamin deficiency, E: Caplan syndrome,  <response>: This is a patient with leg ulcers and abnormal blood counts, including anemia, thrombocytopenia, leukopenia, and neutropenia. The key findings are the leg ulcers, rheumatoid arthritis on immunosuppressive therapy, splenomegaly, and abnormal blood counts. The differential diagnosis includes:B. Felty syndrome: This is the most likely diagnosis given the combination of long-standing rheumatoid arthritis, splenomegaly, and neutropenia. Felty syndrome is characterized by the triad of rheumatoid arthritis, splenomegaly, and neutropenia. Leg ulcers can be a manifestation.A. Venous stasis: This could contribute to the leg ulcers but does not explain the blood count abnormalities. Varicose veins are not described.C. Drug toxicity: Methotrexate can cause cytopenias but is less likely to cause isolated neutropenia. Leg ulcers would not be expected with methotrexate toxicity. D. Vitamin deficiency: While a vitamin deficiency could cause some of the findings, it would not explain the neutropenia.E. Caplan syndrome: This refers to rheumatoid lung nodules rather than leg ulcers, so it does not fit the presentation.B: Felty syndrome 