<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 53-year-old woman presents to her primary care physician with complaints of pain and swelling in her hands and fingers. She states that she has had these symptoms since she was in her 20s, but they have recently become more severe. She states that her wedding ring no longer fits, due to increased swelling of her fingers. She is a 30-pack-year smoker with a body mass index BMI of 31 kgm2. The vital signs include: blood pressure 12278 mm Hg, heart rate 72min, and respiratory rate 15min. On physical exam, a mild systolic murmur is heard over the apex, and her lungs are clear bilaterally. There is swelling of all the digits bilaterally, and a yellow-white plaque is noted beneath 3 of her nail beds. When asked about the plaques, she states that she was given itraconazole for them about 3 weeks ago; however, the plaques did not resolve. When asked further about joint pain, she notes that she has had shoulder and knee pain for the last several years, although she has not sought medical care for this. Which of the following is the best initial step in this patients therapeutic management?? A: Administer indomethacin and sulfasalazine, B: Administer indomethacin and methotrexate, C: Administer sulfasalazine, D: Administer indomethacin, E: Administer methotrexate,  <response>: This is a clinical vignette describing a 53-year-old woman with complaints of pain and swelling in her hands and fingers for many years, which have recently worsened. Key findings include swelling and plaque beneath nail beds, shoulder and knee pain, smoking history, and high BMI. The question asks about the best initial therapy. Based on the chronicity of symptoms, distribution of joint involvement, and nail findings, this patient likely has rheumatoid arthritis. Methotrexate is a first-line disease-modifying antirheumatic drug for rheumatoid arthritis and would be the best initial therapy.B: Administer indomethacin and methotrexate 