Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Dermatomyositis


Related Terms

  • Dermatomyositis Sine Myositis
  • Idiopathic Inflammatory Myopathy
  • IIM
  • Myopathic Dermatomyositis
  • Polymyositis

Differential Diagnosis

Specialists

  • Dermatologist
  • Neurologist
  • Oncologist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Rheumatologist

Comorbid Conditions

Factors Influencing Duration

The individual's response to therapy is a primary factor in determining the length of the disability. Duration varies greatly depending on the individual's age, type and severity of muscle involvement, ability to swallow, and presence of cancer.

Medical Codes

ICD-9-CM:
710.3 - Diffuse Diseases of Connective Tissue, Dermatomyositis; Poikilodermatomyositis; Polymyositis with Skin Involvement

Overview

Dermatomyositis is a fairly rare connective tissue disease in which there is chronic inflammation of the skeletal muscles, generally accompanied by inflammation and degeneration of the skin. The condition may cause disabling muscle weakness.

Dermatomyositis may be triggered by viruses or immune system disorders. Some researchers have theorized that in certain individuals, the condition could be caused by the immune system's efforts to fight off the onset of cancer. Certain types of dermatomyositis also may be related to metabolic abnormalities. The disease generally develops over weeks to months. Periods of remission may occur.

Dermatomyositis is classified, along with other conditions causing inflammation in skeletal muscles, in a group called idiopathic inflammatory myopathies. It is sometimes discussed together with polymyositis, another condition in this group, because both conditions have similar signs, symptoms, and treatment.

Incidence and Prevalence: Globally, dermatomyositis and polymyositis affect about 5 to 10 people in 100,000 ("Dermatomyositis"). Dermatomyositis most commonly occurs in adults aged 40 to 60 and in children aged 5 to 15 (Schumacher 383). Childhood dermatomyositis usually is not associated with a malignancy and is distinct from the adult form.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Women are twice as likely as men to develop the condition.

Source: Medical Disability Advisor



Diagnosis

History: Muscle stiffness, soreness, and weakness are the primary complaints, usually noted first in the shoulders and hips. The weakness affects both sides of the body. Dusky red inflamed rashes may also develop on the face, neck, upper chest, and joint surfaces such as elbows; a reddish-purplish swelling will be seen around the eyelids. These affected areas may be sensitive to sun exposure. Individuals often complain of the inability to climb stairs or raise their arms above their heads due to weakness of the hip and shoulder muscles. Individuals may report fatigue, shortness of breath, coughing, or difficulty in swallowing (dysphagia) or breathing (dyspnea). Symptoms can develop gradually or suddenly; muscle pain is most often reported with sudden onset. Symptoms may have developed after a mild injury or an illness that was accompanied by fever or rash. In extreme cases of muscle weakness, the individual may require a wheelchair.

Physical exam: Weakness may be noted in the neck muscles (particularly at the front of the neck), thighs, hips, and shoulders. The muscles are occasionally tender and swollen. The disease typically causes a red rash on the face, knuckles, elbows, knees, or ankles. This rash may be scaly or smooth. The fingers and nails may be warm and red. Swelling around the eye can be seen, along with a reddish-purplish discoloration of the eyelids. Hardened calcium deposits (calcinosis) may be noted under the skin.

Tests: Blood tests (serology) may show elevated levels of muscle enzymes (creatine phosphokinase, myoglobin, aldolase, and lactate dehydrogenase [LDH]). Tests of the electrical activity of muscles (electromyography) may be conducted to show patterns suggestive of the disease. Magnetic resonance imaging may be used to help detect areas of inflammation in muscles.

Removing a sample of an affected muscle (biopsy), usually from the quadriceps or deltoid, may reveal muscle damage, infection, inflammation, abnormal proteins, or enzyme deficiencies. In older adults, evaluations and accompanying tests may be necessary to detect possible underlying cancer.

Source: Medical Disability Advisor



Treatment

There is no cure for dermatomyositis. The initial treatment for this condition is an anti-inflammatory drug (corticosteroid), first given in high doses and then tapered once improvement begins. A maintenance dose is usually needed indefinitely. If the individual does not respond to steroid treatment, other immunosuppressive drugs may be given alone or with corticosteroids. Intravenous immune globulin (IVIG) therapy may be an option for patients whose dermatomyositis is severe or resistant to other treatment. Antimalarial medications may be given for persistent rash. Individuals with dermatomyositis should be advised to wear sunscreen preparations and protective clothing to avoid potentially harmful sun exposure. Individuals who develop calcium deposits under the skin (calcinosis) may need surgery (excision) to remove the nodules; medication also may be given to prevent calcinosis. A supportive splint may be needed to protect soft tissue and joints. It is often helpful to restrict activities when the inflammation is most intense. Physical therapy may improve flexibility and strength.

Source: Medical Disability Advisor



Prognosis

For those individuals who respond to therapy, the expected outcome is either reduced severity or the disappearance of symptoms (remission). If, or when, relapses occur, individuals will typically respond to therapy again. However, in individuals unresponsive to therapy, progressive muscle weakness may result in permanent disability. The mortality rate rises as the age of disease onset increases, due either to the dermatomyositis disease or to a developing cancer. Death may result from severe and prolonged muscle weakness, malnutrition, pneumonia, or respiratory failure.

Source: Medical Disability Advisor



Complications

Older individuals with dermatomyositis have an increased risk of developing cancer. The malignancy may be present along with the initial symptoms or may develop later. Steroids used to suppress the disease and improve muscle weakness can cause side effects in susceptible individuals, including additional muscle weakness, cataracts, and lowered resistance to infections.

As part of the condition, some individuals develop calcium deposits under the skin (calcinosis) that may be painful and / or become infected. If the muscles in the esophagus are affected, swallowing may become difficult, leading to weight loss and / or malnutrition. Ulceration and bleeding may occur in the individual's gastrointestinal system. If the chest muscles are involved, shortness of breath may occur. If the heart muscles become inflamed, congestive heart failure and arrhythmias may occur.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Accommodations may be necessary based on the severity and type of muscle weakness and the individual's response to therapy. Individuals with dermatomyositis should wear sunscreen and protective clothing to avoid potentially harmful sun exposure. Individuals with progressive or severe muscle weakness may be unable to perform tasks requiring physical strength, flexibility, and / or endurance. Individuals confined to a wheelchair will require accessible work stations.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have muscle stiffness, soreness, and weakness first noted in the shoulders and hips?
  • Are dusky red inflamed rashes seen on the face, neck, upper chest, and joint surfaces such as elbows? Is there a reddish-purplish swelling around the eyelids?
  • Does individual have difficulty swallowing (dysphagia) or breathing (dyspnea), shortness of breath, or coughing?
  • Did individual recently have a mild injury or illness that was accompanied by fever or rash?
  • On exam, was weakness noted in the neck muscles (particularly at the front of the neck), thighs, hips, and shoulders? Are muscles tender and swollen?
  • Was diagnosis of dermatomyositis confirmed?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Was anti-inflammatory medication (corticosteroids) or other appropriate therapy given to suppress immune responses that are causing the condition? If these drugs were ineffective, was individual given intravenous gamma globulin?
  • Did individual have severe muscle weakness and possible permanent damage before therapy began?
  • Did individual receive physical therapy in order to build muscle strength?
  • If medication failed to prevent calcinosis, is surgery indicated to remove nodules?
  • Was individual diagnosed with an underlying cancer accompanying the condition?
  • Did condition improve once the tumor was removed?

Regarding prognosis:

  • If individual has not experienced a remission, was there at least a reduced severity of symptoms?
  • Could another drug or combination of drugs be used more effectively?
  • If this episode is a relapse, has individual again responded to therapy? If not, what other treatment options are available?
  • If muscle weakness has progressed, to what extent does it impact function?
  • If individual is confined to a wheelchair, would an accessible workstation allow individual to continue in occupation?
  • Has individual experienced any complications related to dermatomyositis such as malignancy, calcinosis, acute renal failure, and cardiac, pulmonary, or abdominal problems?
  • Does individual have other conditions such as cancer, diabetes mellitus, or osteoporosis that may impact recovery?

Source: Medical Disability Advisor



References

Cited

"Dermatomyositis." MayoClinic.com. 10 Jul. 2009. Mayo Foundation for Medical Education and Research. 22 Dec. 2009 <http://www.mayoclinic.com/invoke.cfm?id=DS00335>.

Schumacher, Ralph H. "Polymyositis and Dermatomyositis." The Merck Manual of Medical Information. Ed. Mark H. Beers. 2nd Home ed. Whitehouse Station, N.J.: Merck Research Laboratories, 2003. 383-384.

Source: Medical Disability Advisor






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