女性，30岁。反复双手近端指间关节、腕关节肿痛伴晨僵1年半，双肘部伸侧可触及皮下结节，质硬、无触痛。

诊断首先考虑（）

A.脊柱关节病

B.系统性红斑狼疮

C.干燥综合征

D.骨关节炎

E.类风湿关节炎

We went through a period _______ communications were very difficult in the rural areas.

A, which      B, whose         C, in which       D, with which