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.

Lupus Erythematosus, Systemic


Related Terms

  • Discoid lupus
  • Lupus
  • Neuropsychiatric Lupus
  • SCLE
  • SLE

Differential Diagnosis

Specialists

  • Cardiologist, Cardiovascular Physician
  • Clinical Psychologist
  • Dermatologist
  • Nephrologist
  • Neurologist
  • Psychiatrist
  • Rheumatologist

Comorbid Conditions

Factors Influencing Duration

Length of disability depends on the severity of symptoms, the organs involved, and response to treatment. Treatment, particularly prolonged corticosteroid therapy, may produce side effects that can cause disability.

Medical Codes

ICD-9-CM:
710.0 - Diffuse Diseases of Connective Tissue, Lupus Erythematosus, Systemic; Disseminated Lupus Erythematosus; Libman-Sacks Disease

Overview

Systemic lupus erythematosus (SLE or lupus) is an ongoing (chronic) inflammatory connective tissue disease in which the body's immune system malfunctions and attacks healthy tissue (autoimmune disease). SLE is a serious and potentially fatal condition that can inflame and damage the skin, joints, kidneys, heart, lungs, brain, nervous system, and mucous membranes. It is characterized by various symptoms, including skin rash (discoid rash, malar rash), hair loss (alopecia), joint pain and swelling, confusion and cognitive dysfunction, seizure disorders, heart and lung disorders, and kidney dysfunction (glomerulonephritis or lupus nephritis). Symptoms fluctuate and may lessen or disappear periodically without explanation (spontaneous remissions) and then suddenly return or flare (relapses).

The cause of lupus is not known, but research has shown that the autoimmune process in lupus involves a complex interaction between certain genes that increase susceptibility for the disease, hormonal factors, and environmental factors (e.g., ultraviolet light). Tissue damage begins when the immune system fails to recognize "self" cells in the body and activates specialized white cells (T cell and B cells) and a wide range of autoantibodies that attack self cells as though they were foreign. The number and variety of autoantibodies that appear in lupus determine what symptoms will develop, although the level of antibodies is not always proportional to an individual's symptoms. However, high levels of antibodies against C-reactive protein (anti-CRP autoantibodies) are found to correlate with estimations of disease activity (Sjowali).

Skin eruptions, particularly the classic "butterfly" rash (malar rash) across the nose and cheeks, but also other skin lesions (discoid rash), appear in about 80% of lupus patients (Hahn 661). Discoid lupus refers to lupus that only affects the skin (acute, subacute, or chronic cutaneous lupus), producing atrophic skin lesions without systemic disease. Skin manifestations may only affect the head and neck, but if widespread cutaneous disease is present, systemic symptoms are more likely to appear.

Neuropsychiatric lupus is the term applied to central and peripheral nervous system involvement in some individuals diagnosed with SLE. Symptoms may include headache, mood disorders, anxiety, cognitive dysfunction, movement disorders, and cerebrovascular disease including transient ischemic attacks (TIAs) or stroke. Other heart and brain conditions such as hemorrhage, hypertension, atrial fibrillation, tumor, or vascular conditions must be ruled out before this diagnosis applies.

Individuals using certain medications may develop a lupus-like syndrome called subacute cutaneous lupus erythematosus (SCLE), a systemic form of lupus with non-scarring symmetric skin lesions on the neck, both arms, and upper trunk. The drugs most frequently responsible are those used to treat high blood pressure (antihypertensives), the antifungal agent terbinafine, and tumor necrosis factor antagonists. Symptoms of drug-induced lupus are generally milder and resolve when the drug is discontinued.

Incidence and Prevalence: About 239,000 people in the US have either certain or suspected SLE; prevalence is 50 to 100 cases per 100,000 population (Greenspun). Prevalence measured in the white population is 40 per 100,000 and increases to 100 in 100,000 in black and Hispanic populations (Bartels). On average, about 10 in 100,000 population in the US are diagnosed with lupus every year.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors include sex, race, heredity, and exposure to certain medications or viruses. Sex hormones appear to play some role because most cases in women who develop lupus do so during the peak-hormone production of childbearing years. The use of hormone replacement therapy in menopausal women has also been associated with the onset of lupus and flares (Bartels). Men who have the sex chromosome disorder called Klinefelter or XXY syndrome, in which there is hormone imbalance, also are at greater risk than men without the disease (Bartels). In the US, black women appear to be at increased risk of developing lupus. Family members of affected individuals may also be at increased risk. Lupus is diagnosed most frequently in young women in their late teens to 30s, but the disease can also affect children, older women, and men; men can be affected at any age (Bartels). Drug-induced lupus affects men and women equally.

Source: Medical Disability Advisor



Diagnosis

History: The severity of symptoms varies in different individuals and within the same individual over time. Early symptoms may include joint or muscle pain, fever, or migraine-type headaches. Individuals also may report loss of appetite (anorexia), abdominal pain, swollen glands, sensitivity to cold in the fingers, toes, nose, and ears (Raynaud's phenomenon), confusion, feelings of stress, anxiety, weight loss or gain, or a general feeling of ill health (malaise). Visual disturbances may occur, including over-sensitivity to light (photophobia) or blurred vision. The individual may feel pain when taking deep breaths. Most individuals will complain of a skin rash at some time, particularly after exposure to sunlight. Some individuals will report a facial rash as their only diagnostic clue.

Physical exam: The hallmark sign of SLE is the characteristic red, blotchy, butterfly-shaped rash over the cheeks and bridge of the nose. Individuals with SLE also may present with ulcers in the mouth, hair loss, and red, swollen, painful joints. If more systems are involved, signs are related to inflammation in the involved organs. Common findings include inflammation of the lining of the lungs (pleurisy) and the membrane surrounding the heart (pericarditis). Scattered abdominal tenderness may be due to inflammation of the membrane lining the abdominal cavity that is not related to infection (sterile peritonitis). High blood pressure (hypertension) and ankle swelling (peripheral edema) are the most common indications of kidney involvement (renal disease).

Tests: No one test can determine a diagnosis of lupus, but a combination of laboratory tests can help confirm the diagnosis. Inflammation levels may be determined by elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). A complete blood cell count (CBC) may reveal either an elevated or reduced white blood cell (WBC) count, reduced platelet count (thrombocytopenia), or possibly anemia, which in SLE may be caused by chronic inflammation, renal disease, or destruction of red blood cells (hemolysis). Increased blood urea nitrogen (BUN) and creatinine may indicate kidney involvement. Urinalysis may reveal the presence of red blood cells (RBC) and abnormal sediment, also suggesting kidney involvement; tests on a 24-hour urine sample may confirm kidney dysfunction. Blood tests used to detect specific antibodies include tests for ANA (antinuclear antibodies), anti-DNA, anti-Sm, and anti-C-reactive protein. Complement levels (C3 and C4) are sometimes reduced in active SLE because of inflammation-producing immune complexes. Removal of skin tissue for microscopic examination (skin biopsy) also can detect antibodies that are present when the disease is active.

X-rays of painful joints are not always useful in SLE, but may reveal osteopenia and tissue swelling. Muscle testing by electromyography (EMG) and microscopic examination of fluid withdrawn from the joints (synovial fluid) may be done to rule out other connective tissue diseases. Lumbar puncture may be done to evaluate possible infection if fever or neurologic symptoms are present. Spinal fluid may be aspirated and examined for cell count, protein level, and glucose levels if neuropsychiatric lupus is suspected. Chest x-rays may be taken to detect lung damage or dysfunction, and an electrocardiogram (ECG) can detect heart problems such as pericarditis or endocarditis. Brain CT or MRI can be used to evaluate central nervous system (CNS) involvement such as white matter abnormalities, vasculitis, or stroke.

Source: Medical Disability Advisor



Treatment

There is no cure for SLE. The goal of treatment is to reduce inflammation and relieve symptoms. Treatment depends on which organs are affected and whether lupus is mild or severe. Mild lupus may not require treatment. Any drug that may have triggered lupus must be withdrawn or its dosage reduced. Individuals whose symptoms are made worse by sunlight are advised to avoid exposure to sunlight and to use sunscreen. Skin rashes often can be effectively treated with antimalarial drugs, which are also indicated for disease-related fever or pleurisy. Inflammation of the joints (lupus arthritis) is treated with nonsteroidal anti-inflammatory (NSAID) drugs, antimalarial drugs, and sometimes with immunosuppressants. Disease-related muscle inflammation (lupus myositis) can be treated with short-term corticosteroids and an effective exercise program. Corticosteroids may also be prescribed for treatment of neurological symptoms, kidney disease, or severe cases of lupus. Anticancer (cytotoxic) drugs usually are reserved for serious systemic involvement, especially when corticosteroids are ineffective. If the kidneys fail, mechanical support (dialysis) may be required. Psychological needs must be addressed through counseling or other support.

Source: Medical Disability Advisor



Prognosis

Because the course of lupus is unpredictable, the prognosis can vary from relatively inactive disease to progressively more active to fatal. The prognosis for individuals with SLE has improved over the past two decades. The 10-year survival rate exceeds 90% (Bartels). Females with disease onset after age 60 have the most favorable prognosis, although onset after age 50 is rare (Greenspun). Children with SLE have the least favorable prognosis. About one-third of deaths due to SLE are found in individuals younger than age 45, with deaths occurring 5 to 10 years after symptom onset (Bartels). About half of all individuals with lupus experience kidney involvement, which can lead to life-threatening conditions (Bartels). Discoid lupus is not life threatening, but may have pronounced psychosocial and emotional effects (Bartels). Factors aiding this improved prognosis include an earlier, more accurate diagnosis, faster and more effective treatment, availability of dialysis for treatment of kidney failure, and more availability of antibiotics effective in treating infectious complications. In most individuals, the illness pursues a mild, ongoing (chronic) course, occasionally interrupted by relapses of disease activity. For many, the disease will affect only a few organs.

Source: Medical Disability Advisor



Complications

Possible complications include serious impairment of vital organs such as the lungs, heart, brain, or kidneys. Infections that occur due to a compromised immune system (opportunistic infections) are a leading cause of death. Treatment with antimalarial drugs can damage the light sensitive tissue of the back inner portion of the eye (retina). Corticosteroid treatment may cause facial swelling and high blood pressure (hypertension). Other infections such as colds, influenza, or meningitis may worsen symptoms. Some lupus patients may develop other diseases such as scleroderma or Raynaud's phenomenon (Hahn).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions and accommodations are determined by the severity of symptoms and the particular organ or organ system involved. Flexibility and adaptability are necessary because cycles of remission and relapse may hamper the individual's ability to continue long-term tasks. Individuals with lupus may require protection from sunlight provided by sunscreens and protective clothing such as hats. Arthritic symptoms such as joint pain, inflammation, and stiffness may limit tasks requiring manual dexterity or limit standing or sitting for long periods. Certain duties may need to be reassigned and mechanical accommodations such as modifying a workstation or use of special tools or equipment may be needed. Company policy on medication usage should be reviewed to determine if medication to control the symptoms of lupus is compatible with job safety and function.

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:

  • Did individual present with symptoms such as skin rash or lesions, headache, general malaise, fatigue, joint aches and pains, loss of appetite, abdominal pain; swollen glands, sensitivity to cold in the fingers, toes, nose, and ears, confusion, feelings of stress and anxiety, weight loss, or visual disturbances?
  • Has diagnosis of systemic lupus erythematosus (SLE) been confirmed?
  • If diagnosis is uncertain, how have other conditions with similar symptoms been ruled out?
  • Is there a family history of SLE or other connective tissue disorders?
  • Does individual report spontaneous remissions and relapses?

Regarding treatment:

  • Has treatment been aimed at reducing inflammation and relieving symptoms?
  • If symptoms are made worse by sunlight, is individual avoiding exposure to sunlight? Does individual use sunscreen?
  • If a drug triggered the condition, has that drug been withdrawn? Can another drug be substituted?
  • Have antimalarial drugs been effective against skin rash?
  • Was an appropriate exercise program recommended? Is individual complying with exercise plan?
  • If corticosteroids were ineffective against a serious systemic involvement, is use of cytotoxic or immunosuppressive drugs indicated?
  • Has individual experienced kidney failure? If dialysis was necessary, are kidneys functional again?
  • Are individual's psychological needs being met through counseling or other support?

Regarding prognosis:

  • If symptoms persist despite treatment, does diagnosis need to be revisited?
  • Does individual have access to factors indicating an improved prognosis, such as faster and more effective treatment, availability of dialysis for treatment of kidney failure, and more availability of antibiotics effective in treating infectious complications?
  • Does individual have a comorbid condition such as kidney disease, hepatitis, or multiple sclerosis that may complicate treatment and affect recovery?
  • Has individual experienced complications such as impairment of vital organs (lungs, heart, brain, or kidneys), opportunistic infections, retinal damage, or hypertension that may affect recovery?
  • Have cognitive or central nervous system manifestations affected individual’s ability to function?
  • Can employer adjust job responsibilities to accommodate cycles of remissions and relapses?

Source: Medical Disability Advisor



References

Cited

Bartels, Christie M., and Daniel Muller. "Systemic Lupus Erythematosus." eMedicine. Eds. Carlos J. Lozada, et al. 22 Jan. 2009. Medscape. 20 Jul. 2009 <http://emedicine.medscape.com/article/332244-overview>.

Greenspun, Bertram. "Systemic Lupus Erythematosus." eMedicine. Eds. Martin K. Childers, et al. 23 Apr. 2009. Medscape. 21 Jul. 2009 <http://emedicine.medscape.com/article/305578-overview>.

Hahn, Bevrah, and Betty P. Tsao. "Systemic Lupus Erythematosus and Related Syndromes." Kelley's Textbook of Rheumatology. Eds. Edward Harris, et al. 7th ed. Philadelphia: W.B. Saunders, 2004. MD Consult. Elsevier, Inc. 21 Jul. 2009 <http://mdconsult.com>.

Sjowali, Christopher, et al. "Serum Levels of Autoantibodies Against Monomeric C-Reactive Protein Are Correlated with Disease Activity in Systemic Lupus Erythematosus." Arthritis Research & Therapy 6 2 (2004): 87-94. Medscape Today. Medscape. 21 Jul. 2009 <http://www.medscape.com/viewarticle/466990>.

Source: Medical Disability Advisor






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