Thanks for your question on Health Care Magic. I can understand your concern. Breathlessness and fluid around lungs (pleural effusion) is commonly seen in congestive cardiac failure (CCF). So in my opinion, in your case, cardiac diseases should be rule out first. So ecg and 2d echo should be done first. Rheumatoid arthritis can also cause heart damage and heart failure. You are also having high sedimentation rate. This is seen in infection like tuberculosis. Pleural effusion and breathlessness also seen in tuberculosis. So you should first rule out cardiac diseases and than infectious disease like tuberculosis. Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.