Disability in Rheumatoid Arthritis

Functional Impairment, Unpredictability, Treatment, and Work Disability

Rheumatoid arthritis (RA) is a debilitating disease that can affect walking, using your hands, and the ability to manage activities of daily life, including self-care. RA can also lead to function and mobility limitations and even cause permanent disability due to bone erosion (loss of bone) and joint deformity.

Rheumatoid arthritis is an autoimmune, inflammatory disease where the body’s immune system mistakenly attacks healthy tissues. This response—called autoimmunity—causes inflammation (painful swelling) that attacks the linings of joints and other tissues, including the organs, throughout the body. 

RA Disability
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What Is a Disability?

The medical definition of disability, according to the Centers for Disease Control and Prevention (CDC), is any condition of the mind or body that makes it harder for a person to do major activities and participate in the world around them.

A disability can affect a person’s vision, hearing, movement, mental health, cognition (attention, perception, memory, language, learning, and reasoning), and/or social relationships.

A disability can be related to a variety of conditions, including:

  • Congenital conditions present at birth and that continue to affect function as a person ages
  • Gene and chromosome disorders
  • Conditions related to a serious injury, such as brain or spinal cord injury
  • Long-standing diseases, such as diabetes
  • Intermittent diseases, like rheumatoid arthritis and multiple sclerosis
  • Progressive conditions like muscular dystrophy
  • Static conditions, such as limb loss

Many conditions that cause disability are invisible diseases—conditions with symptoms not visible to others. The physical symptoms of rheumatoid arthritis, such as joint pain, stiffness, and swelling, and persistent fatigue, are invisible.

The impairments caused by rheumatoid arthritis can be both visible and invisible. Joint damage might be visible and evident in the hands and fingers, for example. But the effect on the quality of life cannot be seen and impacts many areas of a person’s life, including their work life, social life, and family life.

How RA Affects Physical Function

Rheumatoid arthritis causes inflammation throughout the body, which may eventually limit the joints, cause persistent swelling, and severe pain. Sometimes, RA can be severe enough to limit the ability to stand, walk, pull, lift, carry, reach, and sit for long periods.

It may even make it harder to perform self-care activities like bathing, dressing, and grooming. It may also affect your mobility—the ability to move about freely and easily. Functional impairment and disability in RA are major problems for people with the condition.

A populated-based group study reported in 2018 by the Annals of the Rheumatic Diseases found the prevalence of patient-reported functional disability was 26% in people with RA in the initial study phase and 11% percent in people without the disease. The discrepancy between the two groups continued for almost 20 years of follow-up.

A newer study reported in 2019 in the journal Mayo Clinic Proceedings finds functional disability related to RA joint damage can occur one to two years before receiving a formal diagnosis. Studies like this one indicate how vital is early intervention in rheumatoid arthritis treatment.

It is important for physicians to ask about and for people with RA to speak up about any difficulties they have with carrying out activities of daily living. The sooner your doctor has this information, the earlier intervention in the form of physical and occupational therapy and more aggressive medications can begin.

Unpredictable Nature of RA

One of the biggest challenges of living with RA is its unpredictable nature. Symptoms of the disease—especially joint pain and stiffness and chronic fatigue—can appear overnight, sometimes with no obvious triggers. These disease flare-ups make it harder to focus on career, family, a social life, and making future plans.

A 2017 report in the Annals of the Rheumatic Diseases finds daily and hour variations of pain, fatigue, and low mood are challenging for people living with RA. The report further notes rheumatoid arthritis is often associated with anxiety and mood fluctuations throughout a person’s day.

Depression and anxiety are often related to poorly controlled pain and fatigue, and the stress of living with an unpredictable disease. Talk to your healthcare provider if you find you are struggling to cope with the effects of RA. He or she can offer treatment options or a referral to a mental health professional who can help. 

Treatment Reduces Disability

Starting disease-modifying antirheumatic drugs (DMARDs) as early as six months after a new diagnosis of RA can reduce the risk of disability. The push to treat RA early is important because once the damage has occurred, there is no way to reverse it. Studies have shown that even as early as diagnosis, people with RA may already have joint damage that can be seen on imaging.

A study reported in 2017 in the journal Arthritis & Rheumatology confirms the importance of early treatment in terms of long-term outcomes for people with RA. In this study, researchers followed 602 patients with RA for 20 years and collected data in years 1–3, 5, 7, 10, 15, and 20.

What the researchers found was the patients who did not treat with DMARDs until after six months of diagnosis had higher disability index scores. The researchers further noted those who received later treatment had higher radiological scores (joint damage) at follow-up in comparison to those who were treated early.

RA treatment will continue to advance as researchers work towards optimizing existing therapies and developing newer, more aggressive treatments. To learn more about reducing your risk for RA disability, talk to your healthcare provider.

RA and Your Job

RA can make it harder to do your job. This is due to several factors, including the fact that pain, fatigue, and medication side effects are unpredictable. One day, you wake up able to work and be productive, and the next you may struggle to keep up with tasks.

People with RA also struggle with daily symptoms that make it harder to give their best at their jobs. This includes brain fog, muscle spasms, and flu-like symptoms, such as malaise (generally feeling unwell). Pain, stiffness, and joint mobility can also be severe at times.

Depending on how rheumatoid arthritis affects you on the job, you may struggle with tasks that involve typing, sitting or standing for long periods, bending, lifting, driving, and writing. Some people with RA may have problems with their vocal cords, which further limits them on the job.

Accommodations and Medical Leave

Under the Americans with Disabilities Act (ADA) and the Family Medical Leave Act (FMLA), there are certain job protections people with RA might have.

Under the ADA, you may be able to ask for reasonable workplace accommodations that make it easier to do your job. These accommodations need to be essential for performing the job in the same manner as a person without a disability.

This may include things like an ergonomic keyboard or desk chair, a sit-stand desk, extra breaks to stretch, talk-to-type software for your computer, or a modified work schedule. Of course, accommodations must be reasonable and should not cause undue hardship to the employer.

Under FMLA, people with RA and other chronic illnesses can take up to three months of unpaid leave per year if they are unable to work due to their health. This leave doesn’t have to been taken all at once and can be intermittent (at different times) as needed for short periods.

For example, a person with rheumatoid arthritis may take intermittent leave for two or three days to manage a disease flare-up. Intermittent leave can also be used for medical appointments or appointments for treatments related to RA.

Your employer’s human relations department is the best position to explain how ADA accommodations work and your intermittent leave options under FMLA.

Disability Income

Some employees may offer temporary or permanent disability coverage to an employee who becomes disabled. The Social Security Administration’s Social Security Disability Insurance program is another option for someone with RA who cannot keep working due to disability.

Getting approved for Social Security disability benefits isn’t an easy process. Often, you have to have been not working for an extended period to be approved. Experts suggest hiring an attorney who specializes in Social Security disability benefits to help you with applying and who can help you to improve the chance of approval.

A Word From Verywell

Having rheumatoid arthritis doesn’t mean you will eventually become disabled. Decades ago, there were huge numbers of people with poorly controlled and untreated RA who developed irreversible joint damage. But this is not the case anymore due to more effective medications and treatment strategies. In fact, the outlook for most people with RA has drastically improved.

If you are worried about becoming disabled or are struggling with activities like brushing your teeth, buttoning your shirt, or grasping objects, you need to let your treating physician know. Being open and honest with your doctor about pain, symptoms, side effects, and concerns are the best ways to prevent disability and keep your RA managed.

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