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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.

Polyarteritis Nodosa


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
446.0 - Polyarteritis Nodosa

Related Terms

  • Disseminated Periarteritis
  • Infectious Periarteritis
  • Necrotizing Angitis
  • Periarteritis Nodosa

Overview

Polyarteritis nodosa (PAN) is a chronic inflammatory vascular disease that damages the muscular walls of the body's small and medium-sized arteries. This inflammation disturbs normal blood supply to tissues and causes tissue injury and damage in different areas of the body. This damage is often prominent in the kidneys, peripheral nerves, and abdominal organs, although it may also involve the skin, muscles, joints, brain, eyes, heart, and reproductive organs.

PAN may cause serious damage such as kidney failure and hypertension associated with kidney injury; nerve damage in the arms or legs; stroke, seizure, or sudden alterations in the brain; pain; arterial aneurysms that may lead to rupture or even infarction in the abdomen, bowel, liver, or pancreas; heart attack, pericarditis, or heart failure; skin rashes, nodules, and purpura, a rash caused by bleeding from damaged capillaries.

Although the cause of polyarteritis nodosa is unknown, some experts believe there is an association between the arterial damage and the presence of abnormal immune complexes (portions of antibodies from the body's immune system coupled with viral proteins). Autoimmune disorders such as rheumatoid arthritis, lupus, and Wegener's granulomatosis, as well as hepatitis B or hepatitis C, are associated with this condition.

Incidence and Prevalence: The incidence of polyarteritis nodosa in the US is approximately 9 in 1 million people; the incidence of polyarteritis nodosa in the United Kingdom is approximately 3 or 4 in every 1 million people ("Polyarteritis Nodosa").

Source: Medical Disability Advisor



Causation and Known Risk Factors

Polyarteritis nodosa often develops between the ages of 40 and 50, about twice as many men as women suffer from this condition ("Polyarteritis Nodosa"). In a small amount of cases, the condition affects individuals with an active hepatitis C infection.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms appear gradually, taking weeks or months to develop. Initially, the majority of individuals will have nonspecific symptoms of generally feeling ill (malaise), fatigue, fever, loss of appetite, weight loss, headache, and abdominal pain. Joint and muscle pain, particularly in the calves, is a common complaint. The general nature of these symptoms can make diagnosis difficult until late in the disease, when the individual may experience fluid retention, nausea, and confusion, indicating kidney trouble. There may be nausea, vomiting, or severe abdominal pain. Changes in mental status, numbness, tingling, weakness, slurred speech, or seizures may indicate brain involvement. A rash may develop.

There may be a history of hepatitis B or C or an autoimmune disorder.

Physical exam: Physical findings are nonspecific. Hypertension may be present. Skin abnormalities are observed in many individuals, the most frequent of which is bluish mottled skin of the legs and hands (livedo reticularis), rashes, swelling, and lumps. The arteries of the retina may show changes. There may be wheezing heard in the lungs.

Tests: A complete blood count (CBC) and blood chemistry tests to measure levels of blood urea nitrogen (BUN) and creatinine may be performed, as well as blood tests to determine hepatitis B or C infection. Blood abnormalities may include anemia (low red cell count), elevated white blood cell count, elevated platelet count, and elevated erythrocyte sedimentation rate. Urinalysis typically shows protein and red blood cells and casts. Surgical removal of a piece of affected tissue (biopsy) and microscopic examination can make a definitive diagnosis when the inflammatory changes are seen in the arteries. Examination of arteries by x-rays (angiography) can reveal characteristic changes in the kidney, liver, or intestine.

Source: Medical Disability Advisor



Treatment

No cure exists for polyarteritis nodosa. If there is no hepatitis infection, treatment may consist of high doses of steroids, with tapering of the dose after response is observed. In more severe cases, a drug may be added that suppresses the body's immune response. Treatment can last a year or longer.

In cases of PAN related to hepatitis B, a course of steroids may be followed by plasmapheresis to remove immune complexes. After plasmapheresis is completed, an antiviral medication may be administered. Treatment can last 3 months or longer.

Source: Medical Disability Advisor



Prognosis

With successful treatment, 80% or more of affected individuals will survive at least 10 years or longer after diagnosis (Chung). With treatment, the risk of relapse is only about 10%, although some damaged blood vessels may cause problems later. Some individuals may recover completely. For those left untreated, the 5-year survival rate is an estimated 10% ("Polyarteritis Nodosa").

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Cardiologist, Cardiovascular Physician
  • Dermatologist
  • Gastroenterologist
  • Neurologist
  • Rheumatologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Diabetes
  • Renal disease
  • Renal insufficiency
  • Vascular disease

Source: Medical Disability Advisor



Complications

Kidney involvement occurs in many cases. Inflammation of the gallbladder (cholecystitis) and appendix (appendicitis) can occur. Cardiac disorders such as inflammation of the heart muscle (myocarditis) or its covering membrane (pericarditis) or rhythm disturbances occur in the late stages of the disease. The most frequent causes of death are gastrointestinal hemorrhage and perforation, congestive heart failure, kidney failure, and infections. The individual has a higher risk of developing an infection or cancer.

Source: Medical Disability Advisor



Factors Influencing Duration

Polyarteritis nodosa is a progressive disease. The rate of progression and degree of disability depend on a number of factors, including the promptness of diagnosis and appropriateness of treatment. Factors indicating a prolonged disability are an age older than 50 years and involvement of the heart, kidneys, or intestinal tract.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Because the symptoms vary depending on the stage of the disease, work accommodations should be considered individually. For most individuals, early symptoms are manageable. Few, if any, restrictions may be required.

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 hepatitis B or C? Lupus? Rheumatoid arthritis?
  • Is individual an IV-drug user?
  • Does individual have nonspecific symptoms of malaise, fatigue, weight loss, headache, and abdominal pain? Muscle pain in the calves?
  • Does individual have difficulty breathing? Experience wheezing?
  • Has individual developed acute abdomen (surgical emergency)?
  • Has individual had a stroke, kidney failure, or nerve damage?
  • Was blood pressure elevated on exam?
  • Were skin abnormalities noted, such as livedo reticularis?
  • Were there changes in the retinal arteries?
  • On auscultation, was there wheezing in the lungs?
  • Did individual have a CBC and urinalysis?
  • Were affected arteries biopsied?
  • Was angiography of affected organs done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Was individual initially treated with high doses of steroids? Were doses tapered off later?
  • Were immunosuppression drugs added?
  • Is there kidney or nerve damage from long-term use of the drugs?

Regarding prognosis:

  • If necessary, is individual's employer able to accommodate restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Does individual have any cardiac involvement?
  • Has individual had multiple infections? Developed cancer?

Source: Medical Disability Advisor



References

Cited

"Polyarteritis Nodosa." InteliHealth. 28 Jul. 2004. 19 Dec. 2004 <http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/24696.html>.

Chung, Steve. "Polyarteritis Nodosa." eMedicine. Eds. Christopher C. Luzzio, et al. 9 Jan. 2004. Medscape. 19 Dec. 2004 <http://emedicine.com/neuro/topic314.htm>.

Source: Medical Disability Advisor