A 59-year-old woman complains of pain and edema in the small joints of her hands, shortness of breath, weakness. This condition lasts for 8 years already. Objectively, her body temperature is 37.8 ° C, she has fine punctate hemorrhages on her torso and limbs, ulnar deviation of the hands is observed. The borders of the heart are shifted to the left, a systolic murmur can be detected over the apex. Her pulse is 96 / min. Her blood pressure is 170/100 mm Hg. Complete blood count shows the following: erythrocytes-3.2 10¹2 / L, Hb-108 g / L, leukocytes-6.8 10 % / L, platelets-220-10 / L, ESR-48 mm/hour, C-reactive protein (+++). General urinalysis shows the following: specific gravity-1016, protein-2.8 g / L, leukocytes 10-12 in the vision field, erythrocytes-2-4 in the vision field. What is the most likely diagnosis in this case