What is Psoriatic Arthritis?
Psoriatic arthritis is an inflammatory arthritis of multiple joints that occurs in patients who have psoriasis. Although figures vary, 15-36 % of patients who have psoriasis develop psoriatic arthritis. Approximately 2.4 million Americans have psoriatic arthritis. The psoriasis usually comes first (in 85%) and the arthritis follows, sometimes years later.
In many patients, psoriatic arthritis may resemble rheumatoid arthritis. However, in other patients it looks different. For example, it can affect the lumbar spine and sacroiliac joints (which rheumatoid arthritis does not). Laboratory testing in people with psoriatic arthritis shows a 36% association with HLA-B27 antigen, which is a blood test for a “disease susceptibility” gene. Being positive does not necessarily mean you have psoriatic arthritis, but it increases your risk of developing it. Another disease-susceptibility gene, HLA-C-06 correlates with psoriatic skin manifestations.
What Joints are Affected by Psoriatic Arthritis?
Psoriatic arthritis may affect most any joint(s) in the body.
The hands and feet are commonly affected in psoriatic arthritis, with pain and swelling of the digits and impaired ability to grasp objects, perform fine or gross movements, or perform repetitive activities. It is not unusual to develop considerable swelling of an entire finger or toe (called a “sausage” digit), which can impair function even further.
The hips, knees, shoulders, wrists, and other joints can be affected by psoriatic arthritis. Functional impairment from pain, stiffness, swelling, and deformities in these joints may cause difficulty with standing, walking, reaching above shoulder height, and lifting or carrying objects, at home or at work.
Enthesitisis a common occurrence in psoriatic arthritis. This is an inflammation of the entheses (the sites where tendons and ligaments insert into bone). Common areas affected by enthesitis include the bottoms of the feet (also called plantar fasciitis), Achilles' tendinitis, and inflammation occurring in tendons at the elbows, knees, ribs, spine and pelvis.
Spondylitis and sacroiliitisin psoriatic arthritis are areas of inflammation in the sacroiliac joints and the spine (like what occurs in ankylosing spondylitis). Inflammation in these areas can result in persistent back pain, stiffness, and impaired mobility. If severe or persistent, these symptoms can impair the ability to sit and perform even a “desk job.”
What Must Your Medical Records Have to Show to Get Disability Benefits?
Your medical records are the “heart and soul” of your disability case. A persuasive medical record must confirm that you have psoriatic arthritis. That's usually done by a rheumatologist, who performs laboratory testing (including an HLA-B27 antigen test) and radiographs (with or without MRI's) of the spine and affected joints.
After your diagnosis of psoriatic arthritis has been confirmed, then your doctor must document in your medical records that you have symptoms and resulting limitations from the psoriatic arthritis, like chronic pain, stiffness, and decreased range of motion in the affected areas of your body, and that these symptoms restrict and impair your functional capacity to sit, stand, walk, lift or carry.
How long you can sit/stand/walk and how much you can lift/carry is a “surrogate marker” that Social Security uses to determine what your “Residual Functional Capacity,” and whether you can work or not.
This information is very important to your disability case, and you can help your doctor document this information, by tellinghim/her how long you can sit/stand/walk and the most you can lift/carry at home or at work.
Be a Pro-Active Patient Speaking to Your Doctor
To help your case, you must work proactively with your doctor when it comes to your medical records, because the quality and completeness of the documentation in your file will pretty much determine whether you receive disability benefits or not.
While it's not up to your doctor to decide whether you are entitled to disability benefits (Social Security does that), it is up to your doctor to document all the information that Social Security needs to make its disability benefit decision.
SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).
SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work.
SSA has its own forms that are used for Physical RFC here and for Mental RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.