Disability for Psoriatic Arthritis

Causes, Unpredictablity, Treatment, and Disability Benefits

Psoriatic Arthritis Disability

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​Symptoms of psoriatic arthritis (PsA) can interfere with a person’s job performance and their ability to perform some of the simplest daily activities, such as getting dressed, putting on their shoes, cleaning house, or driving. Research shows a third of people with PsA will claim short-term or long-term disability due to their loss of joint function.

If your symptoms are starting to severely impact your ability to do your job, you might consider applying for disability. Here is what you need to know about PsA disability and how to get your health back on track.

PsA Disability Causes

PsA is a painful and debilitating type of arthritis. It tends to affect people who have psoriasis, a chronic inflammatory condition of the skin. PsA is also a chronic autoimmune disorder known for attacking healthy cells and tissues of the body’s skin and joints.

Inflammation associated with PsA causes pain and swelling of the joints and overproduction of skin cells. Both PsA and psoriasis get worse with time, and people who have these conditions experience periods of flare-up—where disease activity is high—and periods of remission, which symptoms disappear or are significantly reduced.

Inflammatory Arthritis

Although there is no cure for PsA, it can be managed with medications and lifestyle measures. Most people experience significant improvement with the right treatments. However, some may develop disabling symptoms despite treatment.

When the disease is not diagnosed early enough or treatment isn’t successful, it is more likely a person will experience severe and permanent symptoms and joint damage. Chronic inflammation can be considered a disability if a joint is chronically inflamed and loses its function.

Severe PsA fatigue, skin symptoms, and joint pain can become so bad they affect a person's ability to work. The level of disability is often related to joint dysfunction rather than skin symptoms and fatigue alone. Joint dysfunction severity can be confirmed using X-rays and other joint and bone imaging.

Reconstructive Surgery

Some people may need reconstructive surgery in the knees, ankles, or hips. The goal of surgery is to relieve pain and try to restore function so that disability does not affect the ability to be employed or care for yourself.

Reconstructive surgery does not always lead to the desired outcome, and it sometimes can make things worse leading to further disability and loss of joint use. In fact, research suggests up to one-third of people who have a knee or hip replaced continue to experience pain. Additionally, one study from 2017 finds knee replacement had “minimal effects on quality of life,” especially for people with less severe arthritis.

Spine Disorder

Some people with PsA experience spinal damage from the condition. Spinal injury and disorders of the spine are considered disabilities because they restrict movement and cause significant pain. A type of PsA called psoriatic spondylitis is known for causing inflammation and damage in the spine.

Joint Dysfunction

Another debilitating type of PsA is arthritis mutilans (AM). While rare, it is the most severe form of PsA and it is known for destroying the small bones of the hands. AM can cause permanent disability if not properly treated.

Nail Psoriasis

Nail psoriasis is a frequent and disfiguring type of PsA, affecting as many as up to 80% of people with PsA. It can cause disability due to pain and impairments in function and manual dexterity. Nail psoriasis is also a source of emotional distress.

Manual dexterity is a person’s ability to execute movements using hand-eye coordination. This includes activities like writing, grasping and releasing objects, and assembling and constructing tasks. For many adults, their jobs require advanced manual dexterity and nail psoriasis may affect the ability to perform tasks that require fine hand-eye coordination.

PsA is Unpredictable

The course of PsA is variable and unpredictable and range from mild to severe. Sometimes, PsA can be erosive and it causes deformity in up to 60% of people with the condition, according to one 2010 report in the journal Pharmacy and Therapeutics. Additionally, the report says untreated cases of PsA can lead to “persistent inflammation, progressive joint damage, severe physical limitations, disability, and increased mortality.”

The burden of PsA and disability can be substantial and the potential for disability and reduced function seems to increase with the more joints that are affected. Decreased function can affect your performance on the job. According to the one 2019 analysis reported in Rheumatology and Therapy, disease activity, inflammation, and pain all play a part in reduced productivity at work, activity impairment, and presenteeism (a problem where an employee isn’t fully functioning in the workplace due to illness or injury).

Disability progression with PsA doesn’t follow a specific pattern.

PsA can be stable, improve, or worsen, and function can fluctuate. For example, one 2018 report of the literature on PsA physical impairment reported on a longitudinal analysis conducted over a 10-year period. In that analysis, 28% of PsA patients experienced no disability during the observation period, but the remaining patients had impairments or fluctuated disability states. These fluctuations were frequent for the people who had PsA for at least two years.

A second reported study from the same literature review showed higher disease activity and a high number of inflamed joints were predictors of disability. Further, delays in treatment were associated with joint damage and functional disability. This second set of findings stresses the importance of early diagnosis and treatment to limit or prevent disability.

Does Treatment Change with Disability?

Disability from PsA does not change the need for treatment. The goal of treating PsA—with or without disability—is to help manage difficult symptoms. Medications—including traditional disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, and biologic DMARDs, such as Humira (adalimumab)—can treat pain and swelling and work towards preventing further joint damage.

Your doctor may also recommend lifestyle changes—such as healthy eating, weight loss, and quitting smoking—as well as physical and occupational therapy, surgery, or other treatments. Your doctor will likely select a number of aggressive therapies in an effort to get you as close to remission as possible because even at this point, remission is still a possibility.

With severe PsA and disability, it is a good idea to not overdo certain tasks, such as lifting, pushing, and twisting, as these types of activities can cause further joint damage. Make sure you are pacing yourself, resting, and being safe when carrying out daily tasks.

Is PsA a Disability Under Social Security?

PsA is condition of nuisance for some people, but for others it can be a very painful and debilitating disease. If your PsA is causing you significant joint pain and affecting your daily function at home and on the job, it may be a valid reason to put in a Social Security disability application.

Psoriatic arthritis falls under the classification of immune system impairments of the Disability Evaluation Under Social Security. More specifically, it is listed under section 14.09 titled “Inflammatory Arthritis.” If someone meets the requirements under section 14.09, they may be approved for disability payments.

Sometimes, PsA falls under 1.00 "Musculoskeletal System - Adult" in the Disability Evaluation Under Social Security—under section 1.02 Major Dysfunction of a Joint, or 1.04, Disorders of the spine, depending on the nature of their disability.

Even if your PsA disability does not fall under the immune system disorders or musculoskeletal system disorders categories, you may still qualify if you are unable to stay gainfully employed due to your limited ability to work.

You will need to meet the requirements of the impairment listing you are applying under and you will have to prove that PsA limits you. You can accomplish this by providing information from your medical record, including imaging, a letter from your doctor, medical history, and information about your work history and the functional requirements of the jobs you have done.

You can apply for disability benefits as soon as your symptoms start interfering with your work, or as soon as you quit or are terminated because of your condition. You do not have to be disabled for any length of time before you can apply, but you have to prove your disability will prevent you from returning to work for more than a year.

Most disability claims are denied at the application level. If you are denied, you may consider hiring a disability attorney to help you with the appeals process.

Employer Disability Programs

Your current employer may offer disability benefits that can help if you end up unable to do your job because of an accident or illness. Whether PsA is the cause of your disability or not, the disability does not have to be work-related.

Some of these plans require the Social Security Administration to determine if you are in fact disabled. Further, what you receive from Social Security may reduce any disability benefit from an employer plan.

A Word From Verywell

If you end up claiming disability benefits due to PsA, it may be a good idea to use your time off from work to explore new treatments or get a second opinion on your current treatment plan. You should also take the time to focus on your self-care and learning effective coping strategies. PsA disability does not mean your life is over. It just means trying to find your way back to good health. 

 

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Article Sources

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