Does a patient with worsening uncontrolled Rheumatoid Arthritis (RA), uncontrolled Diabetes Mellitus (DM), and uncontrolled Hypertension (HTN) qualify for disability due to severe bilateral hand pain and stiffness, and similar back, shoulder, and knee pain and stiffness, limiting her ability to perform Instrumental Activities of Daily Living (IADLs)?

From the Guidelines

I strongly support the disability application for this patient who is suffering from severe, uncontrolled rheumatoid arthritis, diabetes, and hypertension, as their condition significantly impairs their ability to perform daily activities and work, as highlighted by the 2021 EULAR recommendations 1. The patient's condition has deteriorated significantly, with debilitating bilateral hand pain and stiffness that severely restricts their ability to perform basic self-care activities. Additionally, the patient experiences similar pain and stiffness in their back, shoulders, and knees, further limiting mobility and functionality. Some key points to consider in this case include:

• The importance of a healthy lifestyle in managing rheumatic and musculoskeletal diseases, as emphasized by the 2021 EULAR recommendations 1
• The need for a comprehensive treatment plan that addresses the patient's multiple health conditions, including rheumatoid arthritis, diabetes, and hypertension
• The potential benefits of disability benefits in providing financial support for access to necessary medical care and improving the patient's health status and quality of life The combination of uncontrolled rheumatoid arthritis, which causes joint inflammation, pain, and progressive joint damage, along with uncontrolled diabetes and hypertension, creates a complex medical situation that makes employment impossible at this time. Key aspects of the patient's condition that support their disability application include:
• Their inability to perform instrumental activities of daily living (iADLs), which indicates they would be unable to meet the physical demands of work
• The significant impact of their condition on their quality of life, as highlighted by the 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1
• The need for ongoing medical care and treatment to manage their condition and prevent further deterioration, as emphasized by the 2021 EULAR recommendations 1.

From the Research

Disability Qualification

To determine if a patient with worsening uncontrolled Rheumatoid Arthritis (RA), uncontrolled Diabetes Mellitus (DM), and uncontrolled Hypertension (HTN) qualifies for disability due to severe bilateral hand pain and stiffness, and similar back, shoulder, and knee pain and stiffness, we must consider the impact of these conditions on the patient's ability to perform Instrumental Activities of Daily Living (IADLs).

• The patient's conditions, particularly RA, can lead to significant functional declines and disability if not properly managed 2, 3.
• Effective treatment of RA, including the use of disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, can help reduce disability and improve quality of life 4, 5.
• However, the patient's uncontrolled RA, DM, and HTN, combined with severe pain and stiffness in multiple joints, may significantly limit their ability to perform IADLs, potentially qualifying them for disability.

Treatment and Management

• The use of DMARDs, such as methotrexate, is a key component of RA treatment and can help reduce disease activity and prevent long-term joint damage 2, 3.
• Combination therapy with multiple DMARDs may be necessary to achieve optimal control of RA symptoms 2, 3.
• The patient's treatment plan should be individualized to their specific needs and may involve the use of various DMARDs, as well as other medications to manage their DM and HTN.

Impact on Daily Life

• The patient's severe bilateral hand pain and stiffness, and similar back, shoulder, and knee pain and stiffness, can significantly impact their ability to perform daily activities, including IADLs.
• The patient's uncontrolled RA, DM, and HTN can also contribute to fatigue, decreased mobility, and other symptoms that can further limit their ability to perform daily activities 5, 6.
• A comprehensive assessment of the patient's functional abilities and daily activities is necessary to determine the extent to which their conditions impact their daily life and to inform disability qualification.