If you suffer from a form of arthritis that causes a major joint dysfunction that is so severe that you can no longer work, you may qualify for Social Security Disability benefits. For major joint dysfunctions, Social Security will look first to see if you meet a listing, either under 1.02 or 14.09. Listings a difficult to meet. Please contact a Nampa Social Security Attorney for more information.
A major joint dysfunction is described in Social Security listing 1.02 and is typically demonstrated by gross anatomical deformity and chronic joint pain and stiffness which limits motion. You will need to have objective evidence in the form of MRI, CT or X-ray showing that you have a deformity, joint space narrowing, etc. that could reasonably cause the pain and limited range of motion that you are experiencing.
If your condition involves a hip, knee or ankle, it will have to be so severe that you can no longer ambulate effectively as defined in 1.00B2b of the listing. If your condition involves shoulder, elbow, or wrist, it must result in your inability to perform fine and gross movements 1.00B2c of the listing.
Rheumatoid Arthritis (RA)
Women are 2-3 times more likely than men to suffer from RA. Because RA begins gradually, it is sometimes difficult to pinpoint when it has become disabling. What causes RA is still somewhat of a mystery, but the immune system plays a significant role in the progression of the disease once it has started. RA causes dissolution of the bones known as erosion, which shows up on X-ray and MRI. RA will also generally involve both sides of the body (both hands, both knees, etc), though RA does seem to spread from joint to joint and wear and tear and injury can create an ideal opportunity for the spread of RA.
American College of Rheumatology 1987 – 88 Diagnostic Criteria
For the Classification of Acute Arthritis of Rheumatoid Arthritis.
|1. Arthritis of three or more joint areas||At least three joint areas simultaneously having soft tissue swelling or fluid (not bony overgrowth alone) observed by a physician (the 14 possible joint areas are right or left PIP, MCP, wrist, elbow, knee, ankle, and MTP joints)|
|2. Morning stiffness||Morning stiffness in and around the joints lasting at least 1 hr before maximal improvement|
|3. Rheumatoid nodules||Subcutaneous nodules over bony prominences or extensor surfaces, or in juxta-articular regions, observed by a physician|
|4. Arthritis of hand joints||At least one joint area swollen as above in wrist, MCP, or PIP joint|
|5. Symmetric arthritis||Simultaneous involvement of the same joint areas (as defined in criterion 2) on both sides of the body (bilateral involvement of PIP, MCP, or MTP joints is acceptable without absolute symmetry)|
|6. Serum rheumatoid factor||Demonstration of abnormal amounts of serum rheumatoid factor by any method that has been positive in less than 5 percent of normal control subjects|
|7. Radiographic changes||Typical X-ray changes of RA on PA view of hand and wrist, which must include erosions or unequivocal bony decalcification localized to or most marked adjacent to the involved joints (osteoarthritis changes alone do not qualify)|
|Abbreviations: MCP, Metacarpophalangeal; MTP, metatarsophalangeal; PA, posteroanterior (back to front); PIP, proximal interphalangeal; RA, rheumatoid arthritis.|
|For classification purposes, a patient is said to have RA if he or she has satisfied at least four of the seven criteria. Criteria 1 through 4 must be present for at least 6 weeks. Patients with two clinical diagnoses are not excluded. Designation as classic, definite, or probable rheumatoid arthritis is not to be made.|
American College of Rheumatology Classification of
Global Functional Status in Rheumatoid Arthritis
|Class I||Completely able to perform usual activities of daily living (self-care, vocational, and avocational)|
|Class II||Able to perform usual self-care and vocational activities, but limited in avocational activities|
|Class III||Able to perform usual self-care activities, but limited in vocational and avocational activities|
|Class IV||Limited in ability to perform usual self-care, vocational, and avocational activities|
|Usual self-care activities include dressing, feeding, bathing, grooming, and toileting. Avocational (recreational and/or leisure) and vocational (work, school, homemaking) activities are patient-desired and age- and sex-specific.|
The American College of Rheumatology decided upon a new diagnostic criteria for rheumatoid arthritis in 2010 that require synovitis in at least 1 joint, the absence of another diagnosis that would explain the synovitis, and a total score of at least 6.
American College of Rheumatology Diagnostic Criteria 2010
For the Classification of Acute Rheumatoid Arthritis
Score or Comment
|1. At least 1 joint with clinical synovitis (swelling)||This criterion is for newly presenting patients. Patients with erosive disease typical of RA with a history compatible with prior satisfaction of the 2010 criteria should be classified as having RA. Patients with longstanding disease in whom disease is inactive (with or without treatment) who in the past have satisfied the 2010 criteria should be classified as having RA.|
|2. Synovitis not better explained by another disease||For example, diseases like systemic lupus erythematosus, psoriatic arthritis and gout may need to be considered.|
|3. Joint involvement||Joint involvement means any swollen or tender joint on examination, which may be confirmed by imaging evidence of synovitis. The distal interphalangeal joints, first carpometacarpal joints, and first metatarsophalangeal joints are excluded. Categories of joint distribution are classified according to the location and number of involved joints, with scoring based on the highest possible category based on the pattern of joint involvement.1 large joint = 0 (large joints are shoulders, elbows, hips, knees, ankles)2-10 large joints = 11-3 small joints = 2 (with or without large joint involvement; small joints are metacarpophalangeal, proximal interphalangeal, 2-5th metatarsophalangeal, thumb interphalangeal, and wrist joints)4-10 small joints = 3 (with or without large joint involvement)>10 joints = 5 (at least 1 small joint; the other joints can include any combination of large and additional small joints, as well as other joints not specifically listed elsewhere, such as temporomandibular, acromioclavicular, sternoclavicular, etc.)|
|4. Serology .||At least 1 test result is needed. Negative means to international unit (IU) values no higher than the upper limits of normal (ULN) for the reporting laboratory or assay. Low-positive means IU values that are higher than the ULN but less or equal to 3 times the ULN for the laboratory or assay. High-positive refers to IU values more than 3 times the ULN for the laboratory or assay. Where rheumatoid factor (RF) is only available as positive or negative, a positive result should be scored as low-positive for RF. ACPA refers to anti-citrullinated protein antibodyNegative RF and negative ACPA = 0Low-positive RF or low-positive ACPA = 2High-positive RF or high-positive ACPA = 3|
|5. Acute-phase reactants||At least one test result is needed for classification. Normal/abnormal is determined by local laboratory standards. CRP = C-reactive protein; ESR = erythrocyte sedimentation rate.Normal CRP and normal ESR = 0Abnormal CRP or abnormal ESR = 1|
|6. Symptom duration||Duration of symptoms refers to patient self-report of the duration of signs or symptoms of synovitis (e.g., pain, swelling, tenderness) of joints that are clinically involved at the time of assessment, regardless of treatment status.Less than 6 weeks = 06 weeks or more = 1|
|7. Scoring||A score of 6 or greater is diagnostic of RA. Although patients with a score of less than 6 are not classifiable as having RA, their status can be reassessed and the criteria might be fulfilled cumulatively over time.|
Treatment of RA consists of adequate rest, protection of joints from stress, physical therapy, and drugs. Surgery is sometimes done to help correct joint deformities. It should be stressed that although RA evaluated under this listing 1.02 requires gross joint deformity, such deformity is not required by listing 14.09 for the inflammatory component of rheumatoid arthritis.
The common deformities of the hands seen with RA are ulnar deviation, swanneck deformities, and boutonniere deformity. Drugs used to treat RA include non-steroidal, anti-inflammatory drugs (NSAIDS) such as aspirin or ibuprofen, steroids, gold, methotrexate, etanercept, and others as appropriate. Flare-ups of activity may occur at unpredictable intervals despite treatment; the frequency, duration, and severity of these flare-ups are linked to the behavior of the disease in the individual person.
With modern medicines, many RA patients are able to keep their function if treatment is started early in the onset of the disease, but there is still no fully curative treatment of this disorder. SSA has no standardized guidelines for assessing functional limitations in RA or any other musculoskeletal disorder.
Psoriatic arthritis is equally common between men and women, although the cause is not known. Psoriatic arthritis can produce joint inflammation and is more likely to affect the hand joints nearest the fingertips, and commonly only affects the joints on one side of the body. For example, there may be arthritis in the left hand and knee but none on the right side. Psoriatic arthritis can cause damage to the spine and sacroiliac joints of the pelvis.
There are no diagnostic tests for psoriatic arthritis and sometimes it is confused with gout. In psoriatic arthritis patients, X-ray may show asymmetric joint abnormalities, inflammation of the sacroiliac joint, and in the spine (spondylitis), ankylosis (fusion) of bone in involved joints, erosions of bone with formation of new bone, and resorption (dissolution) of bone in the fingertip bones. Sometimes there is severe finger deformities, but Psoriatic arthritis typically involves mild abnormalities. Less than 5% develop deforming arthritis.
Osteoarthris is the most common form of arthritis. It is not a systemic disease process and is limited to the joints. It progresses slowly and typically starts with damage to joint cartilage, such as from high impact activity, and it is more likely to be associated with advancing age. Trauma to a joint, such as a fracture into a joint space, is frequently followed by development of OA.
Osteomyelitis (bone infection) is a serious condition and most often occurs as a result of trauma producing open wounds that allows the entry of bacteria into the body, as a result of surgical procedures, or as a result of bacteria circulating in the blood stream (“bacteremia)” and results in bone destruction and joint deformity. With modern antibiotics, acute osteomyelitis can be treated more effectively, so that chronic osteomyelitis is not as common as it was in the past.
Gout is usually found in men. Gouty arthritis can almost always be treated with diet and medication. A swollen and painful joint treated with Colchicine will usually return to normal in several days. It is unusual for gout to produce listing level symptoms.
Systemic Lupus Erythematosis (SLE)
SLE is an incurable autoimmune disease, with 90% of cases occurring in women, particularly young women. SLE can affect almost any body system, including joints, although it is unusual for joint deformities to develop in SLE. However, systemic lupus erythematosus can result in the degenerative bone condition of osteonecrosis (ON) that can affect shoulder, hip, knee, and ankle joints and is associated with alcohol and tobacco use, kidney disease, and the corticosteroid drugs sometimes used to treat the SLE.
Scleroderma is a hardening of the skin and is caused by a connective tissue disorder. Connective tissue includes skin, ligaments, bone, muscle, and tendons. Scleroderma can affect a variety of organ systems in addition to skin, such as gastrointestinal, heart, muscles, kidneys, and lungs. Scleroderma is incurable, and there is no effective way to slow it down.
Polymyositis And Reiteris Syndromes
Polymyositis and Reiterís syndromes are less common forms of disease process that can affect multiple body systems including joints.
Severe arthritis can qualify you for Social Security Disability Benefits. Contact a Nampa Social Security Attorney for more information.
Originally posted 2014-01-14 04:59:52.