Cholestasis: Given the elevated alkaline phosphatase (alk phos 124) and slight elevations in AST (41), along with intense itching that is not responsive to topical steroids, cholestasis is a strong consideration. Cholestasis can lead to the accumulation of bile salts in the skin, causing intense itching (pruritus). The patient's medication list, including statins, which can cause liver enzyme elevations, supports this diagnosis.

Primary Biliary Cholangitis (PBC): This autoimmune disease of the liver can cause cholestasis and intense itching. The patient's history of RA (Rheumatoid Arthritis) suggests an autoimmune predisposition, making PBC a plausible diagnosis.
Drug-induced Liver Injury: Given the patient's extensive medication list, including statins, Farxiga, gabapentin, Metformin, Rinvoq, and Seroquel, drug-induced liver injury is a possible cause of her symptoms, including elevated liver enzymes and itching.
Diabetic Pruritus: Although less common, diabetes mellitus (DM) can cause itching due to various mechanisms, including dry skin, neuropathy, or diabetic dermopathy.

Hematologic Malignancy: The slight anemia and elevated lactate dehydrogenase (LDH) level (345) could indicate a hematologic malignancy, such as lymphoma or leukemia. These conditions can cause itching due to the release of pruritogenic substances.
Thyroid Disease: Both hyperthyroidism and hypothyroidism can cause itching. Although not directly indicated by the lab values provided, thyroid function tests would be essential to rule out thyroid disease as a cause of itching.
Obstructive Jaundice: Although the patient does not have overt jaundice mentioned, obstructive causes (e.g., gallstones, pancreatic cancer) can cause cholestasis and itching. The elevated alkaline phosphatase suggests cholestasis, which could be due to an obstructive process.

Polycythemia Vera: A myeloproliferative disorder that can cause itching, especially after warm baths or showers, due to the release of histamine from basophils. The slight anemia does not strongly support this diagnosis, but it's a rare cause of itching worth considering if other diagnoses are ruled out.
Aquagenic Pruritus: A rare condition characterized by intense itching after exposure to water, without any visible skin lesions. This could be considered if other causes of itching are excluded, although it's less likely given the patient's other symptoms and lab findings.