Disability in rheumatoid arthritis

Rheumatoid arthritis is a rare and severe autoimmune disease, the origin of which raises many questions. The essence of RA (rheumatoid arthritis) is a systemic lesion of human connective tissues at the level of cell membranes. First of all, the disease is manifested by problems with the work of small joints.

At the stage of diagnosis of RA, an acceleration of the sedimentation of red blood cells and an increase in the proportion of white blood cells are detected, which usually indicates the infectious nature of the disease. But treating rheumatoid arthritis with antibiotics does not bring relief because RA is the result of the body’s improper immune response to the infection, not the infection itself.

Unfortunately, the disease usually manifests itself in young and middle-aged people. More than 70% of them, as rheumatoid arthritis progresses, first receive the status of temporarily disabled persons, and then a disability group. What criteria are used to assess the working capacity of patients with RA, and how to get social support from the state – we will answer these most important questions today in our article.

Clinical forms of rheumatoid arthritis

It is customary to distinguish mild, moderate and severe forms of rheumatoid arthritis.

The mild form of the disease is characterized by the following symptoms:

• Pain syndrome is weak or absent;

• The articular form of RA progresses slowly or is in remission;

• There are no exudative changes in the joints;

• According to laboratory studies, RA is in the 1st stage of activity;

• According to X-ray examination – in 1 or 2 stages;

• Violation of the joints in stage 1;

• The functional class of the patient is 1st.

The average form of rheumatoid arthritis and its clinical signs:

• The course of the disease is complicated by frequent and prolonged periods of exacerbation;

• There are no complete remissions;

• In the joints, polyarticular lesions are observed;

• According to laboratory tests, the patient has a seropositive status;

• X-ray stage of the disease 2nd or 3rd;

• Violation of the functioning of the joints at the 2nd stage;

• The functional class of the patient is 2nd or 3rd.

About a severe form of rheumatoid arthritis, one has to talk about the following signs:

• The disease proceeds with very long exacerbations, which are replaced by only short periods of improvement in well-being instead of remission;

• The articular form of the disease passes into the articular-visceral form, RA progresses rapidly;

• The disease is complicated by irreversible degenerative changes in the internal organs and nervous system, cachexia occurs;

• X-ray stage of RA 3rd or 4th;

• The functions of the joints are impaired up to the 3rd or 4th stage, and foci of ankylosis appear in them;

• The joints are fixed in a non-functional position.

Disease activity and remission states

The temporary attenuation of the disease, accompanied by an almost complete absence of pain and unpleasant symptoms, is called remission. During these periods, a patient with rheumatoid arthritis is able to lead a normal life and work.

Here are the criteria by which doctors determine the state of remission in patients with RA:

• The patient characterizes his general health as good;

• In the morning, immediately after waking up, movements remain constrained for no more than half an hour;

• Neither sharp nor smooth movements of the limbs cause pain in the patient;

• The inflammatory process in the joints, tendons and periarticular tissues is not observed;

• A laboratory blood test shows the level of ESR in men up to 20 mm / hour, in women up to 30 mm / hour;

• All of the above symptoms persist in a patient with RA for at least two months.

Levels of activity of rheumatoid arthritis

During periods of exacerbation, rheumatoid arthritis is assigned three degrees of activity, depending on the data of a laboratory blood test:

• 1st degree – A2-globulins less than 12%, Y-globulins from 20 to 23%, ESR from 16 to 20 mm / h, CRP +, stiffness of movements after waking up for 30 minutes;

• 2st degree – A2-globulins from 12 to 15%, Y-globulins from 25 to 30%, ESR from 20 to 40 mm / h, CRP ++, stiffness of movements can persist up to 12 noon;

• 3rd degree – A2-globulins more than 15%, Y-globulins more than 30%, ESR more than 40 mm / h, CRP +++, stiffness of movements is observed all day.

X-ray stages of the course of the disease

The use of x-rays is very important for the correct assessment of the condition of a patient with rheumatoid arthritis. According to the data of this survey, the stages of the development of the disease are determined:

• 1st stage – there is osteoporosis of the joints;

• 2st stage – narrowing of the articular cartilage gaps and a few uzuras are added to osteoporosis;

• 3rd stage – patterns become multiple;

• 4st stage – ankylosis of bone tissue occurs.

Degrees of joint dysfunction

Depending on the patient’s ability to move, doctors determine the degree of dysfunction of the joints in rheumatoid arthritis:

• 1st degree – the amplitude of the movement of the hands is in the range from 110 to 170 ° C; elbows, knees, ankles and wrists – at least 50 °C, shoulder and hip joints – at least 70 °C;

• 2st degree – the range of motion of the ankle, knee, wrist and elbow joints is reduced to 20-45 °C; hip and shoulder – up to 50 ° C;

• 3rd degree – for all joints, the amplitude of possible movements does not exceed 15 percent, or the joints are motionless, but are in a functionally useful state;

• 4st degree – complete ankylosis and fixation of the joints in a non-functional position (bent, twisted).

Functional classes of RA patients

The concept of “functional class” is closely related to obtaining disability in rheumatoid arthritis, since this indicator characterizes precisely the patient’s ability to self-service and material self-sufficiency. Here are the functional classes that exist:

• FC 1 – full capacity for work and the possibility of daily self-service;

• FC 2 – the impossibility of performing certain types of work, but maintaining full self-service, despite the difficulties with the work of one or more joints;

• FC 3 – partial loss of the ability to self-service, that is, the emergence of a need for care;

• FC 4 – complete loss of the ability to self-service and work, confined to a wheelchair or bed, the need for constant care and attention.

Complications of rheumatoid arthritis

Against the background of rheumatoid arthritis, complications inevitably arise, moreover, they lead to death. Here is a list of the most likely complications of rheumatoid arthritis:

• Rheumatoid carditis (inflammation of the heart tissue);

• Bilateral scleritis (eye damage);

• Non-Hodgkin’s lymphomas (malignant tumors);

• Myelomas (malignant blood lesions from the group of leukemias);

• Amyloidosis of the kidneys (deposition of protein polysaccharides);

• Hypoplasia of the bone marrow (replacement of bone marrow tissue with adipose tissue);

• Cytopenic syndrome (blood damage);

• Osteopenic syndrome (joint damage).

Prognosis of the disease

The prognosis is considered favorable if the following factors are present:

• A patient with rheumatoid arthritis is a man;

• Fell ill before the age of forty;

• The onset of the disease was sudden and acute;

• The disease lasts less than a year, during which there was at least one stable remission.

The prognosis is unfavorable if there are such signs:

• Rheumatoid arthritis diagnosed in old age;

• The symptoms were erased, the disease developed very slowly;

• After entering the active phase of remission, there is either little or none at all;

• The disease almost immediately affected large joints, bone usuries and ankylosis appeared;

• Exacerbations occur more than three times a year;

• In the first year of the disease, HLA DR/DW4 antigens and high RF titers were detected in the blood.

Differential diagnosis of rheumatoid arthritis

We have to talk about differential diagnosis, because the symptoms of rheumatoid arthritis, especially in elderly patients, are similar to the manifestations of a number of other diseases:

• Sarcoidosis;

• Bechterew’s disease;

• tuberculosis;

• Reiter’s syndrome;

• Psoriasis;

• Osteoarthritis;

• Traumatic and ordinary arthritis;

• Hypertrophic osteoarthropathy.

Most often, the diagnostician is faced with the task of distinguishing rheumatoid arthritis from ordinary arthritis. If the result is disappointing, then the diagnosis may sound something like this:

Methods of treatment of rheumatoid arthritis

If the course of RA is slow or moderate and the disease is only in the articular form, they resort to the so-called topical therapy, which consists in taking non-steroidal anti-inflammatory drugs.

If rheumatoid arthritis develops rapidly, passes into the articular-visceral form, and non-steroidal anti-inflammatory drugs do not bring a positive result, they switch to basic therapy. It includes cytostatics, immunosuppressants and gold-based drugs.

If RA is accompanied by vasculitis and exudative joint lesions, glucocorticoids are added. Steroid hormones are rejected by most doctors. Sometimes surgery is performed to restore joint mobility – a synovectomy, for example.

Temporary disability

Usually, patients with a mild form of RA are recognized as able-bodied, but they need special working conditions, and not every kind of work activity is up to them. During exacerbations and as the patient’s condition worsens, it comes to temporary disability. This status is assigned for different periods depending on the clinical picture:

• VUT for 1 month – exacerbation of RA of the first degree of activity;

• VUT for 2-3 months – rapidly progressing RA of the second or third degree of activity, requiring treatment in a hospital, as well as a synovectomy operation performed on the patient;

• VUT for 3-4 months – articular-visceral form of RA of the third degree of activity or undergone surgery for arthroplasty of large joints.

After the patient returns to duty, the following types of work are contraindicated for him:

• Work in conditions of vibration, high or low temperature, dampness, harmful atmospheric emissions and other adverse factors;

• Any activity related to staying at height, maintenance of heavy potentially dangerous machinery and construction equipment;

• Labor that requires lifting and moving weights, walking for a long time, performing sudden movements, or vice versa, sitting in the same position for hours;

• Work that involves fine motor skills of the fingers and requires extreme precision, such as assembling mechanisms.

Indications for a medical and social examination

If periods of VUT no longer save, and it is time to admit that it is time for a patient with rheumatoid arthritis to receive a disability, he is sent to the ITU (medical and social examination).

Reasons that allow a person diagnosed with rheumatoid arthritis to qualify for disability:

• Catastrophically rapid course of the disease;

• Articular-visceral form of RA with severe complications (vasculitis, amyloidosis, alveolitis, neuropathy);

• The absence of remissions and frequent periods of exacerbations that make further work impossible;

• Complete loss of fitness for work by profession due to immobility of the joints, loss of vision and other objective reasons.

To conduct an ITU, you will need to provide a complete laboratory blood test: for ESR, sialic acids, RF titers, fibrinogen, protein and all fractions. An X-ray examination of the joints will also be required.

Getting Disability with Rheumatoid Arthritis

When making a decision on assigning the status of a disabled person to an RA patient, many factors are taken into account:

• The severity of the disease and the speed of its course;

• The number of exacerbations and remissions over the past year;

• All the stages and degrees listed by us in the previous chapters (disease activity, radiological, joint dysfunction, FC);

• The effectiveness of therapy, the forecasts of the attending physician;

• The social position of a person, his ability (or rather, inability) to serve and provide for himself.

The official cause of disability in rheumatoid arthritis is either “disability since childhood” if the diagnosis was made before adulthood, or “general disease” if the person became ill in adulthood.

Disability groups in rheumatoid arthritis

Group III disability is assigned to patients with RA in the following cases:

• Illness of mild or moderate severity, the first degree of activity;

• The ability to self-service, movement and work is preserved, but not completely;

• A person needs to change the field of activity, improve working conditions, reduce working hours, retrain and social adaptation.

Group II disability is given to a person with a diagnosis of rheumatoid arthritis, if his situation looks like this:

• The form of the disease is moderate or severe, the degree of activity is the second or third;

• The patient needs care, serves himself only partially, movements are severely limited;

• Can only work at home or under special conditions, and only during periods of remission.

Group I disability is determined if:

• Rheumatoid arthritis in a person in severe form and in the third stage of activity;

• The patient cannot move independently (bedridden, uses a wheelchair);

• The ability to self-service and work is completely lost;

• Care and care from third parties are required constantly.

Social rehabilitation of patients with RA

In conclusion, I would like to say a few words about what measures can help a person with a terrible diagnosis of rheumatoid arthritis to adapt to life, realize themselves professionally and simply not feel unhappy and unnecessary:

• At the first signs of RA in yourself or loved ones, sound the alarm and rush to the diagnosis. The earlier the diagnosis is made, the higher the chance of successful treatment. It is impossible to completely get rid of rheumatoid arthritis, but you can drive the disease into deep remission;

• If the diagnosis is made, take an interest in special clinics and charity programs aimed at social and labor adaptation of RA patients. Nowadays, even without being able to move, a person can find work on a home computer or in a special institution for people with disabilities;

• Try to provide the RA patient with a favorable domestic environment, keep him clean. And most importantly – support a person morally and surround him with your care.