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.

Temporal Arteritis

temporal arteritis in 中文(中华人民共和国)

Related Terms

  • Giant Cell Arteritis

Differential Diagnosis

Specialists

  • Rheumatologist

Comorbid Conditions

  • Cancer
  • Immune system disorders
  • Intraocular pressure
  • Leukemia
  • Osteoporosis
  • Polymyalgia rheumatica
  • Ulcer disease

Factors Influencing Duration

Factors influencing the length of disability include the severity of the arteritis; the individual's response to treatment and compliance with corticosteroid therapy, which is an extremely important factor in recovering from temporal arteritis; and the success of any surgical intervention deemed necessary.

Medical Codes

ICD-9-CM:
446.5 - Giant Cell Arteritis; Cranial Arteritis; Hortons Disease; Temporal Arteritis

Overview

A chronic vascular inflammatory disease of unknown origin (etiology), temporal arteritis involves the inflammation of medium- and large-sized oxygen-carrying blood vessels (arteries). The disease is so-called because the branch of the carotid artery leading to the head (the temporal artery) is frequently affected. The temporal artery and its branches supply the structures of the temporal regions of the head above the cheekbones and directly behind the eyes, which are commonly referred to as the temple.

This condition is also called giant cell arteritis because giant cells (a kind of immune cell) may abnormally accumulate in the linings of other arteries. The arterial inflammation (arteritis) found in temporal arteritis leads to narrowing of the arteries and eventually complete blockage of the blood supply to the areas served by the arteries.

Temporal arteritis is most common in individuals over the age of 50. It may be related to the aging process or it may be a disease in which the immune system attacks the individual's own cells (autoimmune disease). Early recognition and treatment is critical to prevent blindness related to inflammation of branches of the ophthalmic artery. Before the eye is affected, headache is the most common symptom.

The American College of Rheumatology's criteria for diagnosis requires three of the following five conditions: development of symptoms in individuals over age 50, new onset of headache or localized head pain, temporal artery tenderness to palpation, decreased pulsations unrelated to atherosclerosis of cervical arteries, and a Westergren erythrocyte sedimentation rate less than 50.

Twenty-five percent of individuals diagnosed with temporal arteritis also have a disease called polymyalgia rheumatica, which is characterized by pain and stiffness in the encircling bony structures supporting the shoulder (shoulder girdle) and the lower limbs (pelvic girdle), specifically the neck, shoulders, lower back, hips, and thighs (Clowse).

Some cases of the disease appear to run in families. Association with the HLA-DR4 genetic marker (haplotype) suggests there may be inherited tendencies. Other possible factors that may play some role in causing or predisposing individuals to this disorder include female sex hormones, immunological factors called cytokines, and chlamydia infection.

Incidence and Prevalence: Temporal arteritis has an estimated incidence of 20 to 30 new cases per 100,000 persons older than 50 years. Temporal arteritis primarily affects whites, specifically those of northern European descent. Women are affected in 80% of cases (Albertini).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Women over the age of 50 of northern European descent have a greater risk of getting this disease (Clowse).

Source: Medical Disability Advisor



Diagnosis

History: Headache is present in more than 85% of individuals, usually in the temporal region on one side. It may worsen at night and is often aggravated by combing the hair or resting the head on a pillow. Visual loss may be the first symptom in half the individuals with visual impairment or sudden and painless blindness. Other symptoms may include low-grade fever accompanied by night sweats, scalp tenderness and burning over one or both temples, jaw pain (jaw claudication) that makes opening the mouth and chewing difficult, a general feeling of uneasiness or indisposition (malaise), fatigue, loss of appetite (anorexia), and weight loss. Less common symptoms are dry cough and painful paralysis of the shoulder.

Physical exam: The temporal artery may be tender when touched (palpated), and the arterial pulse may be absent. The vessel may feel lumpy (nodular) or be visibly enlarged. In individuals presenting with blindness, examination with an ophthalmoscope may not reveal changes in the eye for days or even weeks.

Significant findings in medium- and large-sized arteries other than the temporal artery occur in 15% of individuals with temporal arteritis, sometimes years after diagnosis and treatment of the disease. If the great artery (aorta) and its major branches are affected, physical examination may reveal unequal pulses in the arms, a heart murmur indicating leakage of blood around the valve (aortic regurgitation), or murmurs (bruits) near the collarbone (clavicle) that result from narrowing of the subclavian artery.

Tests: Several blood tests are usually performed when a diagnosis of temporal arteritis is suspected. A complete blood count (CBC) evaluates the presence of anemia, infection, or an inflammatory process. Erythrocyte sedimentation rate (ESR) or measurement of serum alkaline phosphatase levels also help determine the extent of the inflammatory process. Findings indicating the possibility of temporal arteritis include a very elevated ESR, a normal white blood cell count (suggesting absence of infection), and an elevated alkaline phosphatase level. However, these positive results are also found in a number of other diseases, including rheumatoid arthritis, cancer, numerous blood disorders, and liver disease. A definitive diagnosis of temporal arteritis is made from examination of serial biopsies taken from the lining of the temporal artery. More than one tissue sample is required because not all segments of the artery may be involved (skip lesions). Inflammatory changes in the artery lining are found on one side (unilaterally) in 80% to 85% of individuals with the disease. Changes are found on both sides (bilaterally) in 10% to 15% of individuals. Chest x-ray may be a useful screening test for a thoracic aneurysm. Brain MRI, MRI angiography, and ocular pneumoplethysmography may assist in the diagnosis of temporal arteritis.

Source: Medical Disability Advisor



Treatment

If temporal arteritis is suspected, immediate treatment (even before temporal artery biopsies are performed) with high doses of a corticosteroid is required because blockage (occlusion) from inflammation of a branch of the ophthalmic artery, which supplies blood to the eye, the orbit, and neighboring facial structures, can result in permanent blindness.

High-dose steroid therapy continues for 1 to 2 months, or until the inflammation is suppressed and disease activity ceases. Then, the daily corticosteroid dosage may be tapered off. Low-dose corticosteroid therapy may be required for an additional 1 to 2 years. Adding methotrexate to steroids has been shown to be effective in reducing relapses seen with steroid therapy alone.

The ESR is a useful tool in monitoring corticosteroid therapy. As the ESR begins to drop, the daily dosage of corticosteroids may be lowered. Conversely, a rise in the ESR may require an increase in the daily dosage. Once the disease stabilizes, blood tests are done at 1 to 3 month intervals to ensure that the prescribed dosage of corticosteroids is properly controlling the disease. Continued ophthalmologic evaluation is needed to evaluate the effectiveness of treatment and development of any complications involving the eye, such as glaucoma or cataract.

Since corticosteroids increase the loss of calcium from bones and may increase the risk of fractures, particularly the vertebrae in the back, individuals on long-term corticosteroid therapy should be given calcium supplements as well as hormones if bone density measurements suggest decreased bone density (osteoporosis). Medications should be given, such as histamine- blocking agents for protection against gastrointestinal bleeding, a common complication of steroid therapy. Weight gain is another common side effect of long-term corticosteroid therapy and is the result of fluid retention. A low salt and / or a potassium-rich diet can help prevent fluid retention. Potassium replacements may also be necessary.

Individuals taking corticosteroids on a long-term basis must be instructed to inform medical personnel about the use of steroids if emergency treatment is required. This information is critical in preventing shock and other life-threatening complications that can occur if corticosteroids are suddenly withdrawn.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are given for relief of painful symptoms such as headache and pain in the jaw.

Source: Medical Disability Advisor



Prognosis

The prognosis for temporal arteritis is generally good after a course of high-dose corticosteroid therapy for 1 to 2 months, followed by low-dose therapy for an additional 1 to 2 years. After the full course of treatment, most individuals go into complete remission that is maintained even after withdrawal of corticosteroids. The disease may recur, however, and in some individuals it remains active for years. For individuals with other major arteries involved, the outcome depends on the diagnosis and successful treatment of blood supply blockages and aneurysms that threaten major organs.

Source: Medical Disability Advisor



Rehabilitation

Active range of motion physical therapy (in which the individual moves the extremities) may help individuals with temporal arteritis and polymyalgia rheumatica regain and maintain flexibility and strength while corticosteroid therapy brings these diseases into remission. Exercise can also increase an individual's sense of well-being, which in turn can result in an increased appetite and a better nutritional status.

If permanent blindness has occurred, the individual will require a wide range of rehabilitation and supportive interventions to prepare for a life without vision, including grief counseling, physical therapy, occupational therapy, and various types of instruction and training (reading Braille, using a cane or seeing eye dog, using a voice-activated or Braille computer). In most instances, the individual will require at least some degree of retraining in order to be employable again. Families are also deeply affected by sudden blindness of a loved one and can benefit from talking to a social worker or grief counselor.

Source: Medical Disability Advisor



Complications

Left untreated, temporal arteritis causes visual loss and blindness in as many as 50% of individuals. Up to 75% of individuals having visual disturbance in one eye develop visual loss in the other eye within 3 weeks.

If the great artery (aorta) is involved, the individual may develop a thoracic aortic aneurysm several years after the diagnosis of temporal arteritis. An aortic aneurysm is a condition in which the wall of the aorta weakens and may rupture at any time. A ruptured aortic aneurysm is an extreme emergency often resulting in death. Involvement of other arteries in the body can also result in life-threatening conditions such as strokes, heart attack (myocardial infarction), and blockage of the blood supply to other major organs.

When individuals are given high doses of corticosteroids, the body decreases the amount of cortisone it produces. If an individual suddenly stops taking corticosteroids, many side effects can occur, ranging from a feeling of tiredness to complete physical collapse because the body no longer produces an adequate amount of cortisone on its own. Therefore, under the strict supervision of a physician, the dosage of corticosteroids must be reduced very gradually (a process called tapering) so the body can compensate for the reduction by making its own cortisone again.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Generally speaking, no work restrictions or accommodations are required for individuals with temporal arteritis, unless permanent blindness has occurred. Some individuals may perform their jobs in spite of persistent pain until the arterial inflammation is brought under control with corticosteroid therapy. Others may require a shortened workday and decreased responsibility in order to return to work before the disease goes into remission. Others may find it impossible to perform their jobs in the presence of pain. Depending on the nature of an individual's job requirements and physical work environment, permanent blindness will most likely require major work restrictions and accommodations or a classification of permanent disability.

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:

  • Have fever and pain persisted? Have any other symptoms developed that would indicate a source of infection?
  • Has vision deteriorated in any way?
  • Has individual developed muscular weakness or balance problems that might suggest a neurological disease rather than temporal arteritis?
  • Is erythrocyte sedimentation rate (ESR) elevated?
  • Is individual younger than age 50, making the diagnosis of temporal arteritis unlikely?
  • Was temporal artery biopsy positive? If not, are serial temporal artery biopsies needed?

Regarding treatment:

  • Was individual's ESR monitored regularly with blood tests?
  • Was individual treated with high-dose corticosteroid therapy for 1 to 2 months? Was individual careful to take the steroids at the suggested times of the day, in the correct dosage, and with food to decrease stomach irritation? If the corticosteroid therapy is being tapered, was individual careful about following the physician's directions for decreasing dosage?
  • Is individual being followed regularly by an ophthalmologist with adjustment in steroid dosage as indicated?
  • Is rehabilitation needed for persistent visual impairment?
  • Is individual taking a calcium supplement and exercising?
  • Would individual benefit from physical therapy to maintain flexibility and strength until corticosteroid therapy brings the disease into remission?

Regarding prognosis:

  • Has individual experienced any complications related to the diagnosis or steroid treatment? Are complications being addressed in the overall treatment plan?
  • Does individual have a coexisting condition that may complicate treatment or affect recovery?
  • Is visual loss or blindness permanent?
  • Has individual received rehabilitation and supportive interventions to prepare for a life without vision? Would individual benefit from grief counseling?
  • Does individual have access to assistive devices for the visually impaired?
  • Would work accommodations allow individual to continue with present occupation, or is retraining required?

Source: Medical Disability Advisor



References

Cited

Albertini, John G., and Victor J. Marks. "Temporal (Giant Cell) Arteritis." eMedicine. Eds. Russell Hall, et al. 30 Jun. 2003. Medscape. 18 Oct. 2004 <http://emedicine.com/derm/topic417.htm>.

Clowse, Megan. "Temporal arteritis." MedlinePlus. National Library of Medicine. 18 Oct. 2004 <http://www.nlm.nih.gov/medlineplus/ency/article/000448.htm>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.