Arthritis pain disability

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Arthritis is the most common disease associated with disability in the United States.

The following discussion from the Centers for Disease Control (CDC) discusses the problem.

Most Common Causes of Disability Among Americans Aged 18 Years or Older, 1999

• Arthritis or rheumatism: 17.5%
• Spine or back problems: 16.5
• Heart trouble/hardening of the arteries: 7.8%
• Lung or respiratory problem: 4.7%
• Deafness or hearing problem: 4.4%
• Limb/extremity stiffness: 4.2%
• Mental or emotional problem: 3.7%
• Diabetes: 3.4%
• Blindness or vision problem: 3.3%
• Stroke: 2.8%

More facts:

• Nearly 70 million Americans—about one in every three adults—have arthritis or chronic joint symptoms. As the population ages, this number will probably increase dramatically.
• Arthritis is more common among older adults, but it also affects many children and young adults. In fact, 60% of people with arthritis are younger than 65.
• Arthritis is the leading cause of disability among U.S. adults. It limits everyday activities for more than 7 million Americans. By 2020, an estimated 12 million Americans will be limited in daily activities because of arthritis.
• Early and aggressive management of inflammatory arthritis can reduce complications and delay costly procedures like joint replacements.
• Unfortunately, many people with arthritis do not seek health care, probably because they believe nothing can be done to help their arthritis.

The Cost of Arthritis

• The estimated annual cost of arthritis in this country, including lost productivity, rose from $65 billion in 1992 to $82 billion in 1995, an increase of $17 billion in 3 years. More than $22 billion is for medical care.
• Arthritis is responsible for 750,000 hospitalizations and 44 million outpatient visits every year.
• As the U.S. population ages, arthritis-related costs are going to soar dramatically.

Early diagnosis and appropriate management of arthritis, including self-management activities such as self-help courses, weight control, and physical activity, can help people with arthritis function better, stay productive, and have lower health care costs.

• A recent study estimated that an insurer or health care organization that implements the Arthritis Self-Help Course among just 10,000 people with arthritis can expect a net savings of more than $2.5 million over 4 years.
• Achieving a healthy weight lowers a person’s risk for developing osteoarthritis in the knees. It can also slow progression of the disease in people who already have it and delay costly knee replacement surgery.
• Moderate physical activity relieves arthritis pain and stiffness and improves a person's mood and outlook.

Effective Strategies and Promising Approaches

• The Arthritis Self-Help Course, developed at Stanford University, is a 6-week course that teaches people how to manage their arthritis and lessen its effects. Arthritis pain declined by 20% and costly physician visits were reduced by 40% among people who completed the course.
Unfortunately, fewer than 1% of Americans with arthritis participate in such programs, and courses are not offered in all areas of the United States. Making the Arthritis Self-Help Course and other self-management strategies a routine part of health care for people with arthritis should help reduce arthritis-related pain and health care costs.
• Increasing public awareness about the importance of early diagnosis should increase appropriate management for inflammatory arthritis and connective tissue diseases.
• Getting the message out about the benefits of a healthy weight and moderate physical activity should help people with arthritis.

Hope for the Future

CDC is working with the Arthritis Foundation and other partners to carry out the National Arthritis Action Plan: A Public Health Strategy. The plan was developed to guide the use of the nation’s resources to decrease the burden of arthritis for all Americans and increase the quality of life of those affected by arthritis. It provides a blueprint for reducing pain, activity limitations, and disability among people with arthritis, as well as for preventing certain types of arthritis, as called for in Healthy People 2010.

Another study bears these statistics out…

Journal of Aging and Health, Vol. 17, No. 1, 56-69 (2005)
DOI: 10.1177/0898264304272783
© 2005 SAGE Publications

Pain Disability Among Older Adults With Arthritis
Nadine T. James
University of Southern Mississippi
Carl W. Miller
U.S. Navy
Kathleen C. Brown
Michael Weaver
University of Alabama at Birmingham

Objective: The principal objective was to examine pain disability (the degree to which chronic pain interferes with daily activities) among older adults with arthritis. Specifically, answers to two research questions were sought: (a) Does psychological distress reliably predict pain disability; and (b) do certain theoretically important host, sociodemographic, and health-related factors reliably predict pain disability? Method: Descriptive, univariate, and multivariate regression analyses were employed to assess key psychosocial, disease, and host factors among the sample (N =141) of adults with arthritis, aged [UNKNOWN] 50 years old. Results: The resultant regression model accounted for 63.7% (60.0% adjusted) of the variance and was significant at p < .01. Psychological distress, overall health, disease activity, and disease self-efficacy were found to predict pain disability. Discussion: Sample members with greater pain disability experienced heightened psychological distress, poorer perceptions of their overall health, more surgeries, higher unemployment, more intense disease activity, longer disease duration, and lower disease self-efficacy.

For those with arthritis who pursue the disability process, there are a substantial number of barriers. The Social Security Administration has a process called sequential evaluation which they use to determine who receives benefits.

Here is an explanation of Social Security's five-step process to determine if arthritis qualifies for SSDI:

The first step is one where it is simply determined if an individual is "working (engaging in substantial gainful activity)," according to the SSA definition. Earning more than $810 a month as an employee is enough for disqualification from receiving Social Security disability benefits.

The second step implies that the arthritis disability must be severe enough to significantly limit one’s ability to perform basic work activities needed to do most jobs; for example:

• walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
• seeing, hearing and speaking
• understanding/carrying out and remembering simple instructions
• use of judgment
• responding appropriately to supervision, co-workers and usual work situations
• dealing with changes in a routine work setting

The third step asks if the arthritis disability meets or equals a medical listing. Arthritis is considered under the musculoskeletal body system and has several specific medical listings or categories. To satisfy the listing criteria, a person with inflammatory arthritis (such as rheumatoid arthritis) must have:

• persistent swelling
• pain
• limitation of joints (hip, knee, ankle, shoulder, elbow, or wrist and hands)

People who have degenerative arthritis (osteoarthritis) satisfy the requirements if they have:

• significant limitations using their arms/hands
• have a significant problem standing and walking

Those who have significant back or neck problems due to degenerative arthritis must have:

• persistent sensory, reflex and motor loss

However, if a person’s arthritis disability does not satisfy a medical listing, SSA continues to the next two steps to see whether the person might still qualify for disability benefits. At the next two steps, SSA looks primarily at how the actual limitations and symptoms imposed by arthritis affect a person’s ability to perform work. So, at Steps 4 and 5, Social Security looks more specifically at the work-related impact of arthritis.

Step four explores the ability of an individual to perform work he has done in the past despite his arthritis. If SSA finds that a person can do his past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.

The fifth step looks at age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine disability, SSA enlists vocational rules, which vary according to age.

For instance, here is what happens if a person is…

Under age 50 and, as a result of the symptoms of arthritis, unable to perform what SSA calls “sedentary work”, then SSA will reach a determination of disabled. Sedentary work requires the ability to lift a maximum of 10 pounds at a time, sit six hours and occasionally walk and stand two hours per eight-hour day.

Age 50 or older and, due to his disability, limited to performing sedentary work but has no work-related skills that allow him to do so, SSA will reach a determination of disabled.

Over age 60 and, due to his disability, unable to perform any of the jobs he performed in the last 15 years, SSA will likely reach a determination of disabled.

Any age and, because of arthritis, has a psychological impairment that prevents even simple, unskilled work, SSA will reach a determination of disabled.

Unfortunately, people are rejected at the time of first application and even second application. Here is where persistence and the cooperation of the treating physician and disability attorney are required.

Get more information about arthritis pain disability and related conditions as well as...

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