A 58-year-old patient with rheumatoid arthritis develops dyspnea and sharp chest pain; chest x-ray shows a small effusion and nodules. The most appropriate treatment is which?

• A. Acetaminophen.
• B. Indomethacin.
• C. Amoxicillin.
• D. Albuterol.

Answer: (B)

The situation reflects inflammatory pleuritis (serositis) from rheumatoid arthritis, which causes sharp, pleuritic chest pain often with a small pleural effusion and dyspnea. Treating the inflammation of the pleura is key, and nonsteroidal anti-inflammatory drugs are first-line to reduce prostaglandin production and ease pain and inflammation. Indomethacin is a potent NSAID well-suited for RA-related serositis and pleuritis, making it the most appropriate choice here. Acetaminophen lacks anti-inflammatory effects and wouldn’t adequately address pleural inflammation. Amoxicillin would target infection, not inflammatory serositis, and a bronchodilator like albuterol isn’t relevant to pleural inflammation.