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.

Spondylitis


Related Terms

  • Ankylosing Spondylitis
  • Psoriatic Arthritis
  • Pyogenic Spondylitis
  • Reiter's Syndrome
  • Rheumatoid Spondylitis

Specialists

  • Family Physician
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Rheumatologist

Comorbid Conditions

Factors Influencing Duration

Factors influencing length of disability include underlying cause, specific diagnosis, region of the spine and total amount of the spine involved, severity of disease at diagnosis, length of time between development of symptoms and diagnosis, individual’s response to treatment, presence of underlying medical conditions, intravenous (IV) drug abuse, and complications.

Medical Codes

ICD-9-CM:
720.0 - Ankylosing Spondylitis

Overview

Spondylitis is an inflammation of the facet joints between the vertebrae. It may be either infectious or noninfectious in origin and is a feature of several conditions described as spondyloarthropathies, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and arthritis secondary to inflammatory bowel disease (i.e., Crohn’s disease, ulcerative colitis). In addition to inflammation of vertebral joints, these diseases involve some degree of arthropathy, presenting symptoms of arthritis such as pain, swelling, and stiffness of peripheral joints. Most individuals who have these conditions test positive for the human leukocyte antigen HLA-B27, suggesting a genetic origin. This group of spondyloarthropathies are also thought to be autoimmune diseases, but they are seronegative for rheumatoid factor (RF), which is diagnostic for autoimmune rheumatoid arthritis, the most common form of inflammatory arthritis.

Spondylitis resulting from an immune response to infection in another part of the body, as in Reiter’s syndrome, should not be confused with primary infection of bone in the spine (osteomyelitis) or infection of a spinal disc (discitis).

Ankylosing spondylitis is a specific type of spondylitis, characterized by inflammation of the vertebral joints and the joints between the spine and pelvis (sacroiliac joints). Fixed deformity of the spine in the sagittal plane may occur.

Psoriatic arthritis occurs in some individuals with psoriasis, a chronic skin condition. About 1 in 20 individuals with psoriasis will develop symptoms of arthritis along with the skin condition. In general, individuals who have psoriasis have a higher prevalence of arthritis than the general population. The cause of psoriatic arthritis is not known, but genetic factors may play a role.

Reiter's syndrome is an inflammatory complication of previous infection elsewhere in the body. Its symptoms include inflammation of the urethra (urethritis), inflammation of the eye (conjunctivitis), skin lesions, and reactive arthritis.

Undifferentiated spondylitis, not associated with an underlying spondyloarthropathy, is a term used by some physicians to describe back pain of unknown etiology associated with degenerative changes on imaging studies.

Incidence and Prevalence: The exact incidence of spondylitis is not known because it is a feature of a group of diseases. In the US, 0.21% of individuals over the age of 15 are affected by ankylosing spondylitis (Clowse). The prevalence of ankylosing spondylitis in the US is estimated to be 197 individuals in 100,000, which closely parallels the frequency of HLA-B27 (Van der Linden). The incidence rate for Reiter's syndrome is 3.5 individuals per 100,000 in the US and correlates with the incidence rate of urethritis/cervicitis and infectious diarrhea (dysentery) (Scoggins).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The risk of spondylitis increases in individuals with other inflammatory conditions such as psoriasis, Crohn’s disease, or ulcerative colitis. Spondylitis occurs in about 5% of patients with psoriatic arthritis and more often in males than females (Van der Linden). The male-to-female ratio for ankylosing spondylitis is 2:1 to 3:1. Risk is also increased in individuals seropositive for HLA-B27, indicative of a genetic predisposition for ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, and Reiter's syndrome.

Ankylosing spondylitis usually presents between the ages of 20 to 40 and affects more males than females.

Reiter’s syndrome occurs most commonly in men younger than 40 years old.

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of back pain, hip pain, neck pain, fatigue, morning stiffness, or joint pain. Some may report constitutional symptoms such as weight loss and night sweats. Symptoms of skin disease (psoriasis) or inflammatory bowel disease may precede or may follow the onset of back symptoms (spondylitis). The physician may obtain a history of current or prior illnesses and may ask about a family history of spondyloarthropathies.

Physical exam: The exam may reveal decreased movement in the spine, muscle spasms, joint tenderness, and swelling. Eye inflammation may be present, but vision is rarely affected. Skin involvement with psoriasis may be obvious. In Reiter's syndrome, symptoms of conjunctivitis or urethritis usually precede the arthritis symptoms.

Diagnoses are based upon clinical findings of arthritis and associated disorders. Clinical characteristics required to establish a diagnosis include a typical pattern of peripheral arthritis, radiographic sacroiliitis, absence of rheumatoid factor, extra-articular features such as uveitis, and association with HLA-B27.

Tests: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin, hematocrit, blood cultures, and spinal x-rays are performed on most individuals to evaluate the degree of inflammation and possible infection. A serological test for rheumatoid factor (RF) is done to rule out rheumatoid arthritis, and an HLA-B27 assay is performed. The HLA-B27 antigen is found with increased frequency in individuals with Reiter's syndrome, ankylosing spondylitis, psoriatic arthropathy, and enteropathic arthropathy (the arthritis associated with Crohn's disease and ulcerative colitis). Other tests performed are related to the particular cause of the spondylitis, and may include tuberculin skin testing (PPD) and biopsy for culture and sensitivity to rule out brucellosis, tuberculosis, and infectious arthritis (septic arthritis). CT scanning is used to evaluate soft tissue changes in and around the joints. MRI may be used for diagnosis and follow-up evaluation.

Source: Medical Disability Advisor



Treatment

The objective of treatment is to relieve joint pain, maintain mobility, and to prevent or delay deformities. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and a range of prescription medications are used to reduce inflammation and pain associated with the condition. In severe ankylosing spondylitis, surgery may be necessary to improve chin-on-chest deformity or gross lumbar flexion deformity; other deformities may also require surgical treatment. Underlying disease or concomitant infection (possible in Reiter’s syndrome) will be treated simultaneously.

Source: Medical Disability Advisor



Prognosis

The prognosis for the spondylitis associated with psoriasis, inflammatory bowel disease, and Reiter's syndrome is variable. Spontaneous remission is common, as is exacerbation, but the general prognosis is favorable (Van der Linden). Few individuals progress to total immobility of the involved joints (ankylosis). However, the course of the disease is unpredictable; remissions and relapses may occur at any stage. The presence of infection or active chronic inflammatory disease such as Crohn’s disease or psoriatic arthritis can exacerbate spondylitis.

Source: Medical Disability Advisor



Rehabilitation

In general, the treatment of these rheumatologic conditions of the spine is medical (medication), with physical therapy being utilized infrequently. General aerobic conditioning, flexibility, and strengthening exercises may, at times, have a role. Education for body mechanics and proper lifting techniques is important in the rehabilitation process to prepare the individual for returning to work.

Stretching (flexibility) exercises to promote spinal range of motion and exercises to strengthen the lower back and abdominal muscles may be introduced to help prevent poor posture. Even if symptoms of spondylitis are mild to moderate, there are activities that can be done without putting much stress on the spine, such as walking and swimming. It is important that the individual starts any exercise program slowly and gradually builds up the speed and length of time of the exercise to tolerance.

Source: Medical Disability Advisor



Complications

The complications are principally those of the underlying psoriasis, Reiter’s syndrome, or inflammatory bowel disease. Progressive disease may result in deformities. In ankylosing spondylitis, abnormal flattening of the lower spine (loss of lumbar lordosis) and an exaggeration of the curve of the middle (thoracic) spine (kyphosis) may occur, and the deformity may be fixed.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals whose jobs require bending, lifting, and standing may need a transfer to more sedentary duties. If spondylitis heals with residual deformity, heavy work is usually no longer possible. The individual may need to be retrained in a different field. A leave of absence 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 any risk factors?
  • What symptoms does individual have?
  • What findings were present on physical exam?
  • Have tests such as erythrocyte sedimentation rate (ESR), CRP, hemoglobin, hematocrit, HLA-B27 antigen assay, blood cultures, and spinal x-rays been performed to confirm diagnosis?
  • Has an underlying disease been confirmed such as psoriatic arthritis, reactive arthritis (Reiter’s syndrome), or Crohn’s disease?
  • Has individual been evaluated for the possibility of tuberculosis or fungal infection?
  • Have conditions such as spine fractures, a herniated spine disc (vertebral disc), rheumatoid arthritis, osteoarthritis, metastatic bone tumor, or muscle abscess been ruled out?

Regarding treatment:

  • Is individual on appropriate rheumatologic medicine under the supervision of a rheumatologist?
  • Is the underlying diagnosis being treated simultaneously?
  • Is surgery necessary?
  • Has individual received physical therapy?
  • Have walking aids and assistive devices been made available to individual?

Regarding prognosis:

  • Is there any evidence on the x-rays to suggest another diagnosis?
  • Has individual received training for proper lifting of heavy objects?
  • Is individual's employer able to accommodate restrictions if necessary?
  • Does individual have any infection or chronic conditions that might affect recovery?
  • Does individual have any complications?

Source: Medical Disability Advisor



References

Cited

Clowse, Megan. "Ankylosing Spondylitis." MedlinePlus. National Library of Medicine. 28 Oct. 2004 <http://www.nlm.nih.gov/medlineplus/ency/article/000420.htm#Causes,%20incidence,%20and%20risk%20factors>.

Scoggins, Thomas, and Igor Boyarsky. "Reactive Arthritis." eMedicine. Eds. Dana A. Stearns, et al. 15 Feb. 2007. Medscape. 2 Mar. 2009 <http://www.emedicine.com/emerg/topic498.htm>.

Van der Linden, S. "Ankylosing Spondylitis." Kelley's Textbook of Rheumatology. Eds. Edward Harris, et al. 7th ed. Philadelphia: Elsevier, Inc., 2005.

General

"Prevalence and Incidence of Reiter's Syndrome." Cure Research. 28 Oct. 2004 <http://cureresearch.com/r/reiter_s_syndrome/prevalence.htm>.

Source: Medical Disability Advisor






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