<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 35-year-old woman comes to the physician for the evaluation of fatigue over the past 6 months. During this period, she has also had fever, joint pain, and a recurrent skin rash on her face. She has smoked one pack of cigarettes daily for the past 15 years. Her temperature is 38.5C 101.3F, pulse is 90min, and blood pressure is 13080 mm Hg. Physical examination shows a facial rash that spares the nasolabial folds and several oral ulcers. Joints of the upper and lower extremities are tender with no reddening or swelling. Laboratory studies show anti-dsDNA antibodies. The patient is diagnosed with systemic lupus erythematosus and treatment of choice is initiated. Eight months later, the patient has weakness in her shoulders and hips. Examination shows slight weakness of the proximal muscles. Deep tendon reflexes are 2 bilaterally. Laboratory studies show normal erythrocyte sedimentation rate and creatine kinase. Which of the following is the most likely underlying cause of this patients symptoms?? A: Autoantibodies against postsynaptic acetylcholine receptors, B: Dystrophin gene mutation, C: Autoantibodies against myelin, D: Upper and lower motor neuron degeneration, E: Adverse effect of medication,  <response>: This is a clinical vignette describing a 35-year-old woman with a 6-month history of fatigue, fever, joint pain, and facial rash. She is diagnosed with systemic lupus erythematosus SLE and started on treatment. Eight months later, she develops proximal muscle weakness. The key findings are:- Diagnosis of SLE based on clinical features and positive anti-dsDNA antibodies- New onset proximal muscle weakness 8 months after starting SLE treatment- Normal CK and ESRThis suggests a diagnosis of SLE myopathy rather than damage to the neuromuscular junction, muscle, motor neurons or myelin sheath. SLE myopathy is caused by autoantibodies against components of the muscle cell.Of the choices given, autoantibodies against postsynaptic acetylcholine receptors, dystrophin gene mutation, and autoantibodies against myelin can be ruled out based on the clinical scenario. Upper and lower motor neuron degeneration would not present with normal reflexes. The most likely cause is an adverse effect of medication used to treat the patients SLE. Corticosteroids are a known cause of steroid myopathy which presents as proximal muscle weakness.E: Adverse effect of medication 