Social Security Disability Attorneys OC, Riverside & San Bernardino
What is Lofgren's?
Lofgren's syndrome is an acute form of sarcoidosis that has been defined as the triad of erythema nodosum, polyarthritis, and hilar lymphadenopathy. “Erythema nodosum” refers to inflammatory skin lesions, “polyarthritis” refers to inflammatory arthritis with joint pain and swelling, and “hilar lymphadenopathy” refers to inflamed lymph nodes in the chest. Lofgren's is usually thought of as an “acute” disorder, meaning that in many cases the symptoms eventually resolve, but not always. There are chronic cases that continue for many years or even a lifetime.
The type of inflammation in Lofgren's is called “granulomatous,” which means that a biopsy specimen of the skin, for example, will appear under the microscope as a nodular collection of inflammatory cells that are aggregated into focal lesions. The term “granulomatous” is derived from “granuloma” which means “granule,” and “oma” which means “tumor.”
Symptoms of Lofgren's often include pain and inflammation of the ankles. In a study of 186 patients diagnosed with Lofgren's, the mean age was 37 +/- 11 years, and 85% were women. A blood test used to help diagnose Lofgren's called the “angiotensin-converting enzyme” (ACE), was increased in half the patients. With remission, the ACE levels in those patients often went to normal. In many patients, the disease was self-limited, but in about 10%, symptoms persisted or recurred over many years. When internal organ involvement occurred, it was frequently lung involvement. [Ref: Maria, J, et al.” Lofgren's syndrome revisited: a study of 186 patients.” Am J Med. 1999 Sep;107(3):240-5.
It has been estimated that about a third of patients with Lofgren's develop significant complications. African Americans are more commonly afflicted with Lofgren's and may have more severe disease and a worse prognosis. Lofgren's may affect the lungs, heart, eyes, liver, bone marrow, lymph nodes, the brain and nervous system, and skin. Fever, chronic fatigue, and joint pain may occur.
The skin lesions that are seen in Lofgren's, which are called erythema nodosum, represent an inflammatory condition of the skin and the fatty layers beneath the skin resulting in painful, tender, erythematous “nodules” usually along the shins and below the knees.
The finding of erythema nodosum is not specific to Lofgren's syndrome. It can also be seen in drug reactions, infections (e.g., streptococcus or tuberculosis), autoimmune or connective tissue disorders, and in inflammatory disorders of the bowel, such as ulcerative colitis or Crohn's disease.
While many patients with Lofgren's have mild disease that may go away even without treatment, there are some patients who suffer with chronic disease that may last a lifetime. Treatment includes corticosteroids, anti-inflammatory medications, or immunosuppressive medications when required. While treatment is usually effective, there are no known cures. [Ref: Visser H, et al. “Sarcoid arthritis: clinical characteristics, diagnostic aspects, and risk factors.” Ann Rheum Dis. 2002;61(6):499-504.]
Disability Benefits for Lofgren's
Long term disability (LTD) benefits under social security (SSDI) or an employer-sponsored group disability plan (ERISA) depend on whether your condition is “acute” or “chronic,” and what clinical manifestations you have. Just having a diagnosis of “Lofgren's” is not enough to qualify for LTD benefits. Benefits are awarded if the symptoms you have significantly impair your ability to do your “own occupation” or “any occupation” for which you may be suited after considering your age, education, and work experience.
Disability benefits are more likely to be awarded when there is evidence of internal organ involvement, such as the lungs, heart, liver, bone marrow, brain and central nervous system. Chronic fatigue and joint pain may impair function to the point of qualifying for disability benefits.
Your medical records must document (1) your diagnosis of Lofgren's, (2) what symptoms you suffer from, and (3) what occupational activities you are unable to perform because of your symptoms.
For example, if your symptoms from Lofgren's include severe fatigue such that you are unable to sit long enough (usually at least 6 hours out of an 8 hour workday) and have to lie down to rest (e.g., for 2 hours) then you may not be able to perform the material and substantial duties of your job. Your functional capacity may be “less than sedentary,” and you are likely to qualify for an award of LTD benefits.
At Law Med, we understand the law and medicine behind Lofgren's and other disorders and can work with your doctor to help obtain LTD benefits for you.