Manual Single National Disability Rating to Colombia - Decree 917 of 1999 (Part I of II) - Chapter III - 3. RHEUMATOLOGY 3.1 GENERAL

MANUAL SINGLE NATIONAL DISABILITY
(PART I OF II)

CHAPTER III
3. RHEUMATOLOGY
3.1 GENERAL

The rheumatic diseases discussed in this chapter, mainly undertake the associated musculoskeletal or parenchymal involvement from other organs or systems, such as the kidney, lung, heart, central and peripheral nervous system, whose deficiencies should be evaluated in the respective chapters each of them. The various shortcomings of the locomotor system will be analyzed carefully considering the following:

1. Pathology.

2. Medical-surgical therapy applied.

3. Program of physical medicine and rehabilitation

4. Time course of the disease and possible recovery.

5. Degree of permanent functional impairment.

3.1.1 Classification of rheumatic diseases

While the International Classification of rheumatic diseases makes specific distinctions, for practical purposes can be grouped into four main types of pathologies.

1. Inflammatory.

2. Degenerative diseases.

3. Metabolic.

4. Extraarticular.

3.1.1.1 Inflammatory

A. Known Causes:

a) Septic arthritis

b) traumatic arthritis

B. Of Unknown Etiology:

a) rheumatoid arthritis

b) Juvenile Rheumatoid Arthritis

c) seronegative spondyloarthropathies, among which include ankylosing spondylitis, psoriatic arthritis and Reiter's syndrome.

d) Connective Tissue Disorders:

1. Lupus erythematosus.

2. Systemic sclerosis.

3. Dermatomyositis

4. Vasculitis (PAN, ETC.)

5. Mixed connective tissue disease.

6. Sjögren syndrome.

3.1.1.2. DEGENERATIVE

a) Osteoarthritis of the hands.

b) Osteoarthritis of the cervical spine.

c) Osteoarthritis of the lumbar spine.

d) Osteoarthritis of the hips.

e) Osteoarthritis of the knee.

f) Other.

3.1.1.3. METABOLIC

a) Drop.

b) Chondrocalcinosis.

c) Osteoporosis.

d) deposition of hydroxyapatite.

3.1.1.4. EXTRA-ARTICULAR

a) Bursitis.

b) Tendinitis.

c) periarthritis.

d) neural entrapment syndrome (eg carpal tunnel syndrome).

e) primary or secondary fibromyalgia.

3.2 Assessment of the Poor PATHOLOGIES Rheumatologist

3.2.1 EVALUATION CRITERIA

For the evaluation of rheumatological causes the deficiency is essential to note that the diagnosis of these diseases should be performed based on clinical, laboratory and imaging, among others, ensuring that the person has received sufficient and appropriate therapy .

3.2.2 EVALUATION OF IMPAIRMENT OF ARTICULAR RHEUMATIC INFLAMMATORY CONDITIONS

TABLE 3.1: EVALUATION OF IMPAIRMENT OF ARTICULAR RHEUMATIC INFLAMMATORY CONDITIONS

Class Description of criteria Global Deficit (%)

I · There is a possible or probable pathology of rheumatoid arthritis or similar conditions consisting of migratory arthralgias, morning stiffness and no signs of synovitis or deformities, or in general conditions. · Laboratory tests or x-rays have no significant alterations. · The arthralgia, arthritis, or both should be submitted at least

for three months. • There is no limitation of activity of daily living or work. 1-4.9

II • There are symptoms and signs of inflammatory joint disease consisting of: polyarthralgia, symmetrical or migratory polyarthritis, morning stiffness of joints for at least an hour. • Elements of joint synovitis, without distortion or deviation. · Joint motion ranges, though painful, are normal. · The laboratory tests prove the existence of an inflammatory joint disease. ·-Rays may show osteoporosis yuxtaarthicular existence, joint impingement or small joint erosions • The functional capacity is limited in mild or moderate does not prevent the activities of daily living . 5-17.4

III · There is a definite polyarticular inflammatory disease, the symptoms and signs of previous laclos add the existence of deformation, joint deviations, or both. Losexámenes Laboratory and imaging of joint disease are inconclusive. • Measures therapeutic favorably alter the course of the disease are relatively successful. · A moderate to marked limitation of functional capacity to perform activitiesof daily life. • If there is commitment from parenchyma of other organs or systems (kidney, lung, heart, skin, CNS and peripheral), should be evaluated in the respective chapters and combined. 17.5-29.9

IV · polyarticular inflammatory disease active or inactive, classical type with severe musculoskeletal sequelae, muscle or skin (secondary osteoarthritis, subluxation, ankylosis fibrous or bony, muscular atrophy, dermal fibrosis, etc.), Which causes total disability and only allows minimal development of personal activities of daily living. • The radiographic study should demonstrate at least the existence of these joint injuries. 30-45

3.2.3. EVALUATION OF THE DEFICIENCY FOR DEGENERATIVE RHEUMATIC CONDITIONS  

While cartilage degradation is independent of the individual's age, overall it is considered that is not a disease itself that causes a total and permanent disability, except when there is polyarthrosis in weight-bearing joints.

Osteoarthritis alone is painful in acute periods, and inflammatory reactions resulting neighborhood, or by the compressive neurological processes that are seen in the spine. Thus, the weighting of the shortcomings of osteoarthritis should not rely on the existence of the illness, but in the functional limitations of the joints that causes these neurological processes and neural compressive neighborhood. To this end we must refer to the tables to evaluate the range of joint movement and commitment of the Peripheral Spinal Nerves, outlined in the relevant chapters.

TABLE No.3.2. DEFICIENCY DERIVED GLOBAL HAND OSTEOARTHRITIS

Class Description dominant extremity criterion (%) nondominant extremity (%)

Both hands (%)

I Have difficulty with finger dexterity grip force and clamp <50%. 2.5 - 7.4 0 - 2.42.5 - 9.9

II do not have finger dexterity. Clamp and clamp force <20%. 7.5 - 12.5 2.5 - 7.5 10.0 - 20.0

Deserve special mention osteoarthritis of the hip, knee or both, in which the weighted joint range of motion must be added the loss of functioning.

TABLE No. 3.3. DEFICIENCY DERIVED GLOBAL 

Osteoarthritis of the hip, knee or both 

Class Description of criteria Global Deficit (%)

I can stand to stand but walks with difficulty in all areas. 2.5-9.9

II may stand and walk only on flat terrain. 10-17.4

III can stand and walk only with attachments (crutches or canes) and on level ground. 17.5-29.9

IV can be argued to stand but can not walk. 30-45 In all cases should be considered prior to assessing the possibility of surgical treatment (stenting), taking into account the person's access to such treatments.

3.2.4. EVALUATION OF THE RHEUMATIC DISEASES BY METABOLIC DEFICIENCY3.2.4.1 Drop

Sometimes misled by treatments produced recurrent inflammatory joint crisis, which can cause severe deformation, osteolysis, periarticular tophi formation, renal urate deposition. In these cases there may be a physical disability comparable to classes II, III or IV of inflammatory rheumatism. Kidney damage

be assessed as provided in the respective chapter.

3.2.4.2 Chondrocalcinosis most often involves the knees, occasionally the shoulder joints,

wrists and ankles. Repeated crises can determine secondary osteoarthritis as measured by the range of joint motion and functional capacity.

3.2.4.3 Generalized Osteoporosis is a disease of primary or secondary etiology, characterized by bone loss, especially in the thoracolumbar spine, pelvis, hips and wrists, when they are asymptomatic do not produce deficiency. When there is pain or muscle spasm without deformity of the skeleton and achieved a complete remission of symptoms with continued therapy based on hormones and minerals, can be considered an overall deficit of 1 to 5%.

When you need continuous therapy to relieve pain without getting your pardon, is considered an overall deficit of 5 to 10%. For any case, the calculation of the deficit in bone mineral density (BMD) was made in accordance with biotechnology available in the country.

3.2.5. EVALUATION OF IMPAIRMENT OF EXTRA-ARTICULAR RHEUMATISM

Alterations by extra-articular rheumatism correspond to bursitis, tendinitis or repetitive microtrauma periarthritis of origin. The most common locations are: shoulders (bursitis, tendinitis of the supraspinatus, biceps, etc.), Tennis elbow, thumb extensor tendinitis, tendinitis of the flexor muscles of the fingers (trigger finger), peritrocantérica bursitis, bursitis anserine.

In general these diseases that respond well to medical treatment and surgical times, so causing no deficiency. However, few opportunities are consequences to be assessed as provided in the chapter that includes the table of the ranges of joint movement. Neural entrapment: the principal is carpal tunnel syndrome for which diagnosis is essential to carry out an electromyogram and a quantification of nerve conduction velocity of median nerve. 

Although surgical treatment is usually achieved full recovery, sometimes with therapy can belatedly made sequels to be evaluated according to the table of engagement of peripheral spinal nerves. It needed an EMG and nerve conduction velocity in a postoperative time of not less than 6 months before evaluating this condition. When speaking of fibrositis is included in it to those patients with myalgia, arthralgia, paresthesia, muscle spasms, etc., Without a clear organic basis and usually correspond to functional non-psychotic disorders. His assessment falls within the field of psychiatry as always physical examination and laboratory osteoarticular is normal, and if there would be no such radiographic abnormalities of clinical significance.