A 61 year old man who had stroke 2 year ago is on aspirin. He has RA (rheumatoid arthritis) but suffers from pain and can’t tolerate it. He is taking senna for constipation. What is the best med to relieve his pain?

The key is D. Paracetamol. [DMARDs are not painkillers but prevents disease progression in long term. Co-codamol will cause constipation. Patient is already taking laxative! So Co-codamol is not the option. NSAIDs are avoided in one who is already taking aspirin. Here paracetamol is the answer. Sometimes we undertreat patients when other options are risky to avoid more severe complication].