Brief Answer:
re confirm rheumatoid arthritis with anti CCP antibodies

Detailed Answer:
Hello, I am Dr. Mody and I would be addressing your concern .
I would enlist the answers so it's more objective .
1) Most importantly, RA factor is a sensitive test for rheumatoid arthritis but not very specific, it means he may have taken fat or postive , yet NOT have rheumatoid arthritis, As the treatment for rheumatoid arthritis is life long and jihad many side effects, it's better to confirm the diagnosis.
The best teat now is Anti CCP antibody, which should be done if ara factor is postive .
Even if this test is positive start the treatment for rheumatoid arthritis , if negative consult a rheumatologist for detailed discussion
2) Rbbb, in the ecg is not per say due to underlying heart disease but due to asthma and it's very commonly seen is such patients. Nothing to worry about the same .
3) the meds prescribed are ideal for rheumatoid arthritis and should be taken ,
The harm because of rheumatoid arthritis is more to the heart rather than of medication, so the benefits are more with taking of medication you have mentioned .
4) all the medications you have described have a long side effect profile and you should take in under observation of your doctor with regular 3 monthly visit for initial year or so and than as per your doctor .
Cardiac point of view you should take care about the following aspects
1) methotrexate, you should keep a tab on the blood pressure. Keep monitoring the same atleast once a month
2) hcq / sazo. Keep monitor the pulse rate . Report to your doctor if any palpitations. Also a ecg once in 3-6 months for monitoring the corrected qt interval should be done .
Hoping other side effects and precautions about the meds monist be discussed by your general physician.

Now the meds you take for heart do not interact with the RA medication very frequently however you should consider 2 things
1) liver enzyme monitoring as both methotrexate and atorvastatin may harm the same
2) ecg monitoring for rhythm disturbance and if any palpitations, as calaptin , methotrexate, sazo all may interact for the same .
3) taking sazo for long periods is fine, foliate supplements should continue.

As I said though side effects are many , however the benefit is far more than the risk and side effects are not very frequent, so proper monitoring is the key in his case .

Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX

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