Disability with rheumatoid arthritis
Rheumatoid arthritis is a rare and serious 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 ailment is manifested by problems with the work of small joints.
At the stage of RA diagnosis, 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 offer relief because RA is a consequence of the body's inappropriate immune response to infection, not the infection itself.
Unfortunately, the disease usually occurs 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 the disability group. What criteria is used to assess the work capacity of patients with RA, and how to get social support from the state - we will answer these most important questions in our article today.
Content:
- Clinical forms of rheumatoid arthritis
- The states of activity and remission of the disease
- Rheumatoid arthritis activity levels
- X-ray stages of the course of the disease
- Joint dysfunction
- Functional classes of RA patients
- Complications of rheumatoid arthritis
- Disease prognosis
- Differential diagnosis of rheumatoid arthritis
- Treatments for rheumatoid arthritis
- Temporary disability
- Indications for medical and social examination
- Getting a disability with rheumatoid arthritis
- Disability groups for rheumatoid arthritis
- Social rehabilitation of patients with RA
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:
- The 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 data - in 1 or 2 stages;
- Dysfunction 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;
- The joints show polyarticular lesions;
- According to laboratory studies, the patient has a seropositive status;
- X-ray stage of the disease, 2nd or 3rd;
- Dysfunction of the joints at the 2nd stage;
- Patient's functional class is 2nd or 3rd.
We have to talk about a severe form of rheumatoid arthritis with the following symptoms:
- 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 becomes articular-visceral, RA rapidly progresses;
- The disease is complicated by irreversible degenerative changes in the internal organs and the 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 low-functional position.
The states of activity and remission of the disease
A temporary attenuation of the disease, accompanied by an almost complete absence of pain and unpleasant symptoms, is called remission. During these periods, the 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 RA patients:
- The patient characterizes his general state of 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;
- There is no inflammatory process in the joints, tendons and periarticular tissues;
- 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.
Rheumatoid arthritis activity levels
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%, U-globulins from 20 to 23%, ESR from 16 to 20 mm / hour, CRP +, stiffness of movements after waking up for 30 minutes;
- 2nd degree - A2-globulins from 12 to 15%, U-globulins from 25 to 30%, ESR from 20 to 40 mm / hour, CRP ++, stiffness of movements can persist until 12 noon;
- 3rd degree - A2-globulins more than 15%, U-globulins more than 30%, ESR more than 40 mm / hour, 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 development of the disease are determined:
- 1st stage - osteoporosis of the joints is observed;
- 2nd stage - the narrowing of the articular-cartilaginous fissures and a few usurs are added to osteoporosis;
- 3rd stage - the usurs become plural;
- 4th stage - ankylosis of bone tissue occurs.
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 hand movement 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;
- 2nd 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;
- 4th degree - complete ankylosis and fixation of joints in a non-functional position (bent, twisted).
Functional classes of RA patients
The concept of "functional class" is closely related to disability in rheumatoid arthritis, since this indicator characterizes the patient's ability to self-service and material self-sufficiency. Here are the functional classes:
- FC 1 - full working capacity and the possibility of daily self-service;
- FC 2 - the impossibility of performing some 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, confinement 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, and it is they that 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 leukemia group);
- Amyloidosis of the kidneys (deposition of protein polysaccharides);
- Bone marrow hypoplasia (replacement of bone marrow tissue with adipose tissue);
- Cytopenic syndrome (blood damage);
- Osteopenic syndrome (joint damage).
Disease prognosis
The prognosis is considered favorable if the following factors are present:
- A patient with rheumatoid arthritis is a man;
- Sick under 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 is diagnosed in old age;
- The symptoms were erased, the disease progressed very slowly;
- After entering the active phase, remissions are either little or not at all;
- The disease almost immediately struck large joints, there were bone usuria and ankylosis;
- Exacerbations are observed more often than three times a year;
- In the first year of the disease, HLA DR / DW4 antigens and high titers of RF were found 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;
- Ankylosing spondylitis;
- Tuberculosis;
- Reiter's Syndrome;
- Psoriasis;
- Osteoarthritis;
- Traumatic and common 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:
Seropositive systemic rapidly progressive rheumatoid arthritis with fever, anemia, lymphadenopathy, and glomerulonephritis. Activity of the second degree, radiological stage three, dysfunction of the joints of the second degree, FC 3.
Treatments for 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, becomes an 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, add glucocorticoids. Steroid hormones are rejected by most doctors. Sometimes surgery is done to restore joint mobility - synovectomy, for example.
See also: All modern treatments for rheumatoid arthritis
Temporary disability
Usually, patients with mild RA are recognized as able-bodied, but they need special working conditions, and not every type 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 progressive RA of the second or third degree of activity, requiring treatment in a hospital setting, as well as a synovectomy 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 stay at heights, maintenance of heavy potentially dangerous machinery and construction equipment;
- Labor that requires lifting and moving heavy weights, walking for a long time, performing sharp movements, or vice versa, sitting in the same position for hours;
- Work involving fine motor skills of the fingers and requiring extreme precision, such as assembling mechanisms.
Indications for medical and social examination
If the periods of VUT no longer save, and the time has come to admit that it is time for a patient with rheumatoid arthritis to receive a disability, he is referred to the ITU (medical and social examination).
Reasons that allow a person diagnosed with rheumatoid arthritis to claim disability:
- Catastrophically rapid course of the disease;
- Articular-visceral form of RA with severe complications (vasculitis, amyloidosis, alveolitis, neuropathy);
- Lack of remissions and frequent periods of exacerbations, which make further labor activity impossible;
- Complete loss of fitness for work in the profession due to joint immobility, loss of vision and other objective reasons.
To carry out MSE, you will need to provide a complete laboratory blood test: for ESR, sialic acids, RF titers, fibrinogen, protein and all fractions. You will also need an X-ray examination of the joints.
Getting a disability with rheumatoid arthritis
Many factors are taken into account when deciding whether to grant a disabled person to an RA patient:
- The severity of the disease and the rate of its course;
- 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 dysfunctions, FC);
- The effectiveness of therapy, predictions of the attending physician;
- The social position of a person, his ability (or rather, inability) to serve and provide for himself.
As the official reason for disability in rheumatoid arthritis, either "disability from childhood", if the diagnosis was made before adulthood, or "general disease", if a person fell ill in adulthood, is indicated.
Disability groups for rheumatoid arthritis
Disability group III is assigned to patients with RA in the following cases:
- The disease is mild or moderate, the first degree of activity;
- The abilities for self-service, movement and work are 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 diagnosed with rheumatoid arthritis, if his position looks like this:
- The form of the disease is medium or severe, the degree of activity is second or third;
- The patient needs care, serves himself only partially, movement is severely limited;
- He can work only at home or in special conditions, and only during periods of remission.
I group of disability is determined if:
- Rheumatoid arthritis in humans in severe form and in the third stage of activity;
- The patient cannot move independently (bedridden, uses a wheelchair);
- The ability for self-service and work is completely lost;
- Care and attention from third parties is required at all times.
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 a diagnosis has been made, take an interest in special clinics and charitable 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 living environment, keep him clean. And most importantly - support the person morally and surround him with your care.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
