Pain and Discoloration of Fingertips

A 53-year-old website developer complained of pain and discoloration of fingertips after cold exposure. Upon his arrival nurse notice a sharp demarcated color change in 2nd, 3rd, and 4th fingers on both hands as shown in the image. On physical examination, both hands were cold, radial pulse 85 bpm, and 3+ bilateral. No numbness, tingling, burning sensation, or any skin abnormality. He had chronic systemic lupus erythematosus that was diagnosed eight years ago and denies drinking alcohol, cigarette smoking, or a history of a heart condition. His lab result reveals the presence of proteinuria and hematuria in urinalysis, antinuclear antibody titer of 1:2,560, and normal creatinine level. Renal biopsy indicated stage V membrane lupus nephritis, which was conducted due to proteinuria. Based on the patient’s history and physical examination findings, which of the following is the most likely diagnosis?

Based on the patient’s history and physical examination findings, which of the following is the most likely diagnosis?

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