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.

Reactive Arthritis


Medical Codes

ICD-9-CM:
099.3 - Venereal Diseases, Other; Reiters Syndrome (Disease)
711.10 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Site Unspecified
711.11 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.12 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Upper Arm; Elbow Joint; Humerus
711.13 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Forearm; Radius; Ulna; Wrist Joint
711.14 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.15 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.16 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.17 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.18 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.19 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Multiple Sites

Related Terms

  • Nongonococcal Urethritis
  • Peripheral Arthritis
  • Reactive Arthritis
  • Reiter's Disease
  • Reiter's Syndrome
  • Reiter's Urethritis

Overview

Reiter syndrome is an inflammatory complication arising from an autoimmune response to a previous infection by specific organisms elsewhere in the body in a genetically susceptible individual. It is considered a rheumatic disease in the category of seronegative spondyloarthropathies, including ankylosing spondylitis, psoriatic arthritis, arthropathy associated with inflammatory bowel disease, or juvenile chronic arthritis. The syndrome is a group of symptoms that includes inflammation of the urethra (urethritis), inflammation of the eye (conjunctivitis), skin lesions, and reactive acute nonpurulent arthritis. Arthritis is typically asymmetric and can affect the weight-bearing joints of the lower extremity, most frequently at the knee and ankle. Less commonly, arthritis due to Reiter syndrome also may affect the metatarsophalangeal joints, heel, shoulder, wrist, hip, or lumbar spine.

Reactive arthritis is most often triggered by intestinal (enteric) or urogenital infections, and the infective organisms are typically either enteric or venereal. Most cases of Reiter syndrome occur within 2 to 4 weeks of a sexually transmitted chlamydia (Chlamydia trachomatis) infection (postvenereal) or a gastrointestinal infection (postdysenteric) (Lozada). Dysenteric infections caused by Salmonella enteritidis, Streptococcus viridans, Mycoplasma pneumoniae, Shigella flexneri, Yersinia enterocolitica, and Y. pseudotuberculosis, or Campylobacter, among others, can lead to Reiter syndrome. Reiter syndrome itself is not an infection, and it is not contagious. Ten percent of individuals are not actually diagnosed with a preceding symptomatic infection (Lozada). Bacterial antigenic material or viable but aberrant causative organisms can sometimes be identified in joint fluid (synovial fluid) or synovial biopsy specimens.

Incidence and Prevalence: Reiter syndrome is a rare disease estimated to occur in 3.5 to 5 individuals per 100,000 in the US (Lozada). Its occurrence correlates with HLA-B27 prevalence and the incidence rate of urethritis/cervicitis and infectious diarrhea (dysentery) (Lozada). In Finland, where the incidence of HLA-B27 is higher in the population, about 2% of males have Reiter syndrome after nongonococcal urethritis (Lozada). In the United Kingdom, the incidence is 0.8% following urethritis (Lozada). A high prevalence of chlamydial infection in a given population can increase the incidence of Reiter syndrome.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report initial symptoms of burning or stinging with urination and a constant urge to urinate, and discharge may be seen from the urethra (urethritis). This may be followed by fever, a vague feeling of bodily discomfort (malaise), fatigue, and weight loss. There may be redness, pain, and discharge from the eye (conjunctivitis), or eye pain, photophobia, and tearing (uveitis). Pain and stiffness in the joints (asymmetric oligoarthritis) then occurs over the next several weeks, typically in the hip, knee, ankle, feet, and lower back, sometimes radiating to thighs and buttocks. Painless ulcers can occur in the mouth, and a skin rash may develop that resembles psoriasis. Individuals may report a recent history of dysentery (diarrheic disease) or sexually transmitted disease.

Physical exam: The exam may reveal inflammation of the eye, skin lesions, inflammation of the urethra, a tender prostate in men, or an inflamed cervix in women. Joints may be swollen and tender, with stiffness interfering with range of motion. Inflammation of the entheses, the spots where tendons or ligaments insert into bones (enthesitis), manifesting as Achilles tendinitis, plantar fasciitis, or digital periostitis, is common and characteristic.

Tests: Tests are not typically used to make a diagnosis, but joint x-rays and a blood test for the genetic marker HLA-B27 may be performed. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) may be done to evaluate the extent of the inflammatory process. Other blood tests such as a complete blood count (CBC) and a routine blood chemistry panel may be performed to evaluate the individual's general health status and to rule out diseases or conditions other than Reiter syndrome. The individual may be tested for rheumatoid factor (RF) to rule out rheumatoid arthritis or other rheumatic disease, and the individual will be tested for HIV. Cultures may be done on cervical or urethral discharge or joint fluid to identify any infectious agent. A special culture may be performed for chlamydia since this organism is often difficult to grow and diagnose and is associated with Reiter syndrome. Stool cultures may also be done, even though no bowel symptoms are present.

Source: Medical Disability Advisor



Treatment

The syndrome is self-limiting and not treatable, but specific symptoms can be treated. Conjunctivitis and skin sores typically resolve without treatment. Active infection such as cervicitis or urethritis can be treated with antibiotics.

Nonsteroidal anti-inflammatory drugs (NSAIDs) as well as corticosteroids are used to treat arthritis associated with Reiter syndrome. Sometimes simple bed rest can reduce pain and inflammation caused by arthritis associated with Reiter syndrome. Severe symptoms of Reiter syndrome may be treated with immunosuppressive drugs that reduce the abnormal immune response and resultant inflammatory process.

Prevention and appropriate treatment of sexually transmitted disease and dysentery may prevent Reiter syndrome.

Source: Medical Disability Advisor



Prognosis

For most individuals, symptoms of Reiter syndrome are severe for the first few weeks and resolve fully in 3 to 12 months without treatment, although there is a high tendency of recurrence (Lozada). Symptoms recur in 15% to 50% of cases (Lozada), and individuals will typically have symptoms that include back pain and arthritis.

About 15% to 30% of individuals will experience chronic, severe, deforming arthritis (Lozada). Underlying infections resolve with antibiotic treatment.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Cardiologist, Cardiovascular Physician
  • Dermatologist
  • Infectious Disease Internist
  • Internal Medicine Physician
  • Orthopedic (Orthopaedic) Surgeon
  • Rheumatologist

Source: Medical Disability Advisor



Rehabilitation

Individuals with arthritis associated with Reiter syndrome may benefit from physical or occupational therapy. Therapists instruct individuals in the use of heating pads as needed for pain control and to decrease joint stiffness, and in gentle stretching and strengthening exercises for the affected joints. Individuals learn to perform these exercises independently to help reduce impairment due to progressive arthritis. Individuals also perform low-impact aerobic exercise such as walking, stationary bicycling, or swimming in order to increase strength and endurance and decrease fatigue. Physical therapists can order assistive devices for walking, such as a cane or walker, that decrease stress through the legs. For those individuals with arthritis in the fingers, wrist, and hand, occupational therapists can order adaptive equipment to reduce the stress these joints experience in daily activities. Therapists address any fatigue or shortness of breath that may occur during activities of daily living (ADLs), and may teach energy conservation techniques in which ADLs are broken up into smaller components to make tasks more manageable.

Individuals with heart rhythm or heart valve disturbances associated with Reiter syndrome should attend outpatient physical and occupational therapy at a clinic specializing in cardiac rehabilitation. Cardiac rehabilitation centers offer electrocardiogram (ECG) monitoring of all participants during the exercise sessions. Additionally, individuals learn to self-monitor their pulse and perceived exertion so they can perform exercise within safe parameters.

Source: Medical Disability Advisor



Comorbid Conditions

  • Autoimmune diseases (e.g., rheumatoid arthritis, lupus)
  • HIV/AIDS
  • Obesity

Source: Medical Disability Advisor



Complications

In rare cases, aortic insufficiency and irregular heartbeats (arrhythmias) may occur.

Source: Medical Disability Advisor



Factors Influencing Duration

Disability is influenced by the severity and duration of the arthritis. Recurrent episodes will result in greater disability over time and will require progressively longer durations of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If arthritic joint pain is severe, modifications may be necessary during weight-bearing activities. When hips or lower extremities are involved, limited stair climbing, squatting, and kneeling are advised. Additional rest periods may be needed. Accommodations must be made for supportive devices such as canes, braces, stools, or wheelchairs. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Risk: Jobs with frequent public contact, in particular at health care facilities that serve an indigent population, may place an individual at increased risk of new contact with the bacteria that cause this infection and thus of a recurrence.

Capacity: During the first few weeks of infection, the individual may require temporary reassignment to more sedentary job duties if heavy or very heavy work is involved. Individuals with increased urinary frequency may need frequent restroom access, and those with eye pain or photophobia may need to work in a darkened environment until the acute symptoms resolve. Capacity depends on the severity and location of symptoms. Work capacity of those affected by lower extremity joint involvement may rarely be permanently reduced.

Tolerance: Tolerance factors include the severity and location of symptoms and the associated discomfort. For individuals with severe joint pain, work accommodations may be necessary to reduce physical exertion and weight-bearing activity.

Accommodations: Work accommodations may be needed to enable individuals with acute Reiter syndrome to continue performing their job assignments.

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 of irritation to the eyes and skin? Did associated joint pain, swelling, and stiffness occur?
  • Were constitutional symptoms such as fever and malaise present?
  • Was cervicitis or urethritis present? Did individual present with current or recent diarrheal condition?
  • Have diagnostic tests been done to identify underlying infection or to rule out other conditions with similar symptoms such as gonorrhea, rheumatoid arthritis, inflammatory bowel disease, rheumatic fever, ankylosing spondylitis, and psoriasis or psoriatic arthritis?
  • Has diagnosis of Reiter syndrome been confirmed, based on the physical exam and history?
  • Did individual test positive for HLA-B27?
  • Was individual tested for HIV?
  • Was individual tested for rheumatoid factor (RF) to rule out rheumatoid arthritis?
  • Was synovial fluid tested for the presence of specific bacteria?

Regarding treatment:

  • Were specific symptoms of arthropathy treated with bed rest and anti-inflammatory agents? Corticosteroids?
  • Were anti-inflammatory and/or immunosuppressive medications effective in resolving pain and inflammation?
  • Was an active infection present?
  • Were culture and sensitivity testing done to identify causative organism and determine the most effective antibiotic to use?

Regarding prognosis:

  • Has a 6-month period passed without resolution of symptoms?
  • Are symptoms persisting, or is this a recurrence of Reiter syndrome? If symptoms persist, should diagnosis be revisited?
  • Would individual benefit from consultation with a specialist such as an infectious disease specialist, a rheumatologist, an orthopedic surgeon, a cardiologist, or a dermatologist?
  • Have any complications developed as a result of Reiter syndrome (joint and bone damage or cardiac abnormalities)? If so, are these conditions being addressed in the treatment plan?

Source: Medical Disability Advisor



References

Cited

Lozada, Carlos J., et al. "Reactive Arthritis and Reiter Syndrome." eMedicine. 13 Mar. 2014. Medscape. 9 Jun. 2015 <http://emedicine.medscape.com/article/331347-overview>.

Source: Medical Disability Advisor