How the Social Security Administration Views Rheumatoid Arthritis and other Inflammatory Arthritis
The Social Security disability evaluation guidebook "Disability Evaluation Under Social Security" has an impairment listing that specifically deals with rheumatoid arthritis and other inflammatory arthritis. Listing 1.02 specifically lists the criteria needed for a meet or equals the rheumatoid arthritis or other inflammatory arthritis disability listing. Listing 1.02 Active rheumatoid arthritis and other inflammatory arthritis states that an individual must meet or equal both A and B of the listing.
Part A of the listing states that an individual must have a three month history of constant joint pain, swelling and tenderness that involves multiple major joints defined as the hip, knee, shoulder, ankle, elbow, or hand and wrist. There must be signs of joint inflammation, swelling, and tenderness upon physical examination in spite of treatment with considerable restriction of joint function. Addition, these symptoms must be expected to last for twelve months or more. Along with part A and individual must meet the following part B criteria:
Individuals with RA must have had a corroboration of their diagnosis, meaning positive Serologic test for one of the following:
- Antinuclear antibodies-ANA (about thirty for forty percent of individual diagnosed with RA have elevated numbers of antinuclear antibodies. This test can support a diagnosis of RA but it cannot be use alone to confirm RA); or
- Elevated sedimentation rate-ESR (a common hematology test with no specific measure of inflammation ESR can be increased by any cause or focus of inflammation. Women generally have a higher basal ESR rate); or
- Rheumatoid Factor -RF (is the antibody most commonly found in rheumatoid arthritis cases. However, it important to note that some individual with RA will show a negative RF. In fact about fifteen percent will be seronegative. There can be false positives and negatives with the RF however if an individual has a positive result with sings and symptoms the test can support a diagnosis and be an indicator of a prognosis. Some medical professional believe the higher the RF rate the greater the possibility of destruction)
- Biopsy of synovial membrane or subcutaneous nodule (this biopsy must be done by an outside source)
The above criteria are used to meet or equal the rheumatoid arthritis impairment listing. However, there are many individuals with RA who may not meet or equal the listing criteria who may still be approved through medical vocational allowances.
Medical vocational approvals are based on medical information and other factors such as: age, education, work history, and residual functional capacity. If an individual's arthritis has caused them to have a severely restricted residual functional capacity, they may still be approved for disability benefits through Social Security even though they do not meet or equal the impairment listing criteria.
Information About the Conditions Themselves
Rheumatoid Arthritis is an autoimmune disorder that can affect organ systems as well as joints. Rheumatoid arthritis is an inflammatory process that affects multiple joints simultaneously, thus it is classified as a polyarthritis. Rheumatoid arthritis affects joints on both sides of the body; this symmetry is used to distinguish RA from other forms of arthritis on examination. This autoimmune disease is characterized by joint pain and stiffness that is more pronounced in the morning, along with fatigue. The cause of rheumatoid arthritis is unknown, however it is thought that RA is caused by a combination of factors that include genetic, hormonal, and environmental components.
Most medical professionals agree that there is a triggering mechanism involved with RA and that once it is triggered immune cells (white blood cells) from the blood begin to invade the joint and joint linings (synovium). Once they invade the joint and joint lining, white blood cells begin to release inflammatory substances that cause irritation, inflammation, swelling of the joint linings (synovitis), and cartilage destruction. As the cartilage wears out the joint space narrows and bone rubs against bone. Additionally, the joint lining may expand and invade the bone, and cause irreversible bone damage. As the RA progresses it causes the joints become painful, swollen, and warm to the touch.
Rheumatoid arthritis is diagnosed through signs and symptoms in conjunction with objective testing. To diagnose rheumatoid arthritis, medical professionals first consider the location and symmetry of the painful joints and if an individual is suffering from stiffness that is worse in the morning or after long periods of inactivity (i.e. sitting or lying down), and/or if rheumatoid nodules are present.
If physical examination suggests rheumatoid arthritis, there should be a thorough evaluation to include various imaging techniques such as x rays or MRI imaging and blood work. Generally, individuals with rheumatoid arthritis develop deformities in bones and joints that are easily detected through x rays or MRI imaging. In addition to imaging techniques there are a few blood tests may indicate the presence of RA. Most physicians use the RF (rheumatoid factor, ANA (antinuclear antibody) test, or the ESR (erythrocyte sedimentation rate) test to confirm a diagnosis of rheumatoid arthritis.
Rheumatoid arthritis is most often a progressive disease that continues over a lifetime. Early intervention may slow the process and lessen the severity of the damage. Women are about two to three times more likely to have RA than men. This is not surprising; women seem to be affected by autoimmune and inflammatory disorders more often than men. There is no known cure for rheumatoid arthritis; all treatments aim at lessening the effects of the disease. Currently treatment involves anti-inflammatory drugs, disease modifying anti rheumatic drugs (DMARD), and analgesics for pain.
There are other types of inflammatory arthritis including ankylosing spondylitis, reactive arthritis (Reiter Syndrome), and psoriatic arthritis. Anlylosing Spondylitis affects men three times more than women and it is an inflammatory condition of the large joints and spine. Reactive arthritis is a form of inflammatory arthritis that is a response to a genitourinary tract infection or a gastrointestinal infection. This causes inflammation of the joints, locations where the tendons attach to the bone, and rashes. Psoriatic arthritis is a type of inflammatory arthritis that affects about one third of individuals who have psoriasis. It is a painful condition that generally affects the hips knees, and joint closest to the tip of the fingers and toes.
All types of inflammatory arthritis can be very debilitating, and may at some point render an individual incapable of maintaining substantial work activity. If an individual is unable to work due to an inflammatory arthritis they should consider filing for one or both of the Social Security disability programs. Studies indicate that about one third of all individuals with RA are not able to work within five years of being diagnosed with RA and that half will have significant functional limitations ten years after being diagnosed.
