Nancy Hardin, age 71, of Dyersburg, Tenn., was diagnosed with rheumatoid arthritis (RA) 11 years ago. A few months after her diagnosis, she quit her teaching job at a local high school because she could barely walk. Then she started taking the biologic drug Remicade and became nearly symptom-free. Nevertheless, she decided that going back to the classroom would wear her out. She did, though, become a volunteer translator for local Spanish-speaking immigrants and a member of the Tennessee Council on Developmental Disabilities. "To tell you the truth," she says with a laugh, "I work almost as much as I did when I was teaching. My doctor thinks my disease is in remission."
Hardin's working experience is not atypical. Close to one out of every three employees with rheumatoid arthritis (RA) leaves the workforce. That statistic may sound daunting, but the percentage of people with RA who quit working because of the condition is nearly half of what it was just 20 years ago. What's more, Hayes Wilson, MD, chief of rheumatology at Piedmont Hospital in Atlanta, tells WebMD that fewer people experience the same level of disability that once was common with RA. "Not only have I seen more people keep working" he says, "I've also seen people who've gone from being almost crippled to leading normal lives."
What has brought about such a dramatic change in RA's impact on people's ability to work? One factor, doctors say, is the use of newer, more effective medications that slow the progress of the autoimmune disease and often suppress its symptoms. Biologic medicines, such as the one Hardin takes, and disease-modifying antirheumatics like methotrexate have made it possible for people to go about their day at work with fewer problems. Still, though, it isn't easy to manage a job when you have rheumatoid arthritis.
That's because even with the newer, more expensive therapies, people with RA may still experience symptoms like fatigue and pain. And these symptoms can significantly interfere with job performance. If you have RA, here is information experts shared with WebMD that you can use to reduce the effect RA can have on your working life.
How does RA interfere with a person's ability to work?
Richard Pope, MD, is a rheumatologist and professor at the Feinberg School of Medicine at Northwestern University in Chicago. He tells WebMD that measuring how much time employees take off work can show how effective their therapy is.
In one recent survey of people with RA, researchers found that over a three-month period, employees with rheumatoid arthritis took off an average of two to three weeks from work. In an earlier study, researchers noted that many employees with RA not only altered their working hours but also either changed their job or pursued a different career altogether.
According to Pope, the newer medicines for rheumatoid arthritis seem to work best for employees who have been diagnosed for less than 10 years and don't have joint deformities. But medication isn't the only factor. Pope says that age, occupation, education level, and duration of the disease are all predictors of work disability among people with rheumatoid arthritis.
What can people with RA do to make it easier to do their job?
The Arthritis Foundation offers the following suggestions for making it easier to stay in the workplace:
- Maintain a positive attitude.
- Create an efficient work environment so you limit the amount of lifting, reaching, carrying, and walking you do.
- Try not to sit in one position or do repetitive activity for long periods of time.
- Set priorities and pace yourself. Do the most important tasks while you feel strongest and most energetic.
- Maintain a schedule. Go to bed at a regular time and get enough rest to carry you through the next day.
Tom Juneman of Houston has another important suggestion: Let your employer know what your limitations are, and ask if you can take breaks throughout the day.
Juneman, 55, communicates well with his boss, he says, so that he knows when a report is due and plans his day accordingly. When he teaches religious school he sits down between classes. When he uses an adding machine in his bookkeeping job, he favors the fingers that are "less worn" to do the job. Juneman, 55, also swims every morning.
Juneman was diagnosed with RA as a college student 35 years ago and now takes the biologic drug Remicade. "I still have fatigue," he says. "I tend to stay close to my coffee and sodas, but I try not to overdo it. I really have to learn to get proper sleep and rest, which I didn't do in my earlier life."
What type of workplace modifications help people with rheumatoid arthritis?
The U.S. Labor Department's Job Accommodation Network has provided a list of recommendations for employers of people with arthritis and arthritis-related conditions. You can use the following list to help you discuss workplace accommodations with your employer. The recommendations include:
- adjusting desk height if an employee uses a wheelchair or scooter
- allowing a flexible work schedule or allowing the employee to work from home
- implementing an ergonomic workstation design
- installing automatic door openers
- providing a page turner, book holder, or note taker, if necessary
- providing arm supports and writing and grip aids
- providing parking close to the workplace
- providing sensitivity training to co-workers
- reducing or eliminating physical exertion
- replacing small switches with cushioned knobs that can be turned with less force
- scheduling periodic breaks away from the workstation
Your right to have accommodations made for you is protected by law. The Americans with Disabilities Act (ADA) protects employees from discrimination based on their disability. Federal law defines a disability as a physical or mental impairment that limits a major life activity. It prohibits employers from:
- not making reasonable accommodations to the known physical or mental limitations of disabled employees
- not advancing employees with disabilities in the business
- not providing needed accommodations in training
What if I can't work and need to apply for disability?
You may qualify for disability benefits from Social Security if you are unable to do any substantial work and your medical condition has lasted at least one year. You can apply online by going to www.socialsecurity.gov. You may also call your local Social Security office to make an appointment and obtain the forms. Phone numbers for local offices are provided on the Social Security web site.
What type of documentation do I need to get Social Security disability benefits?
To apply for disability benefits, you will need to complete an application for Social Security Benefits and an Adult Disability Report. The report collects detailed information about your medical condition and how it affects your ability to work. Again, you can find all the requirements online or get the information by phone from your local Social Security office.
When you apply, you'll need to have many items ready. Some examples include:
- your doctors' names and addresses
- a list of the medicines you're using
- your birth certificate
- your latest tax returns
- worker's compensation information
- checking and savings account numbers
- the Social Security numbers of your spouse and minor children
You could also be asked to take a medical test or have an examination. Just having a doctor say you are disabled doesn't mean that the Social Security administration will determine that you are disabled. To determine disability, you must be unable to do any substantial work due to your medical condition(s) and the medical conditions must be expected to last, or have lasted at least a year, or be expected to result in your death.
Decisions about disability qualification are generally made in three to five months. Sometimes, though, it takes more than one application. If your request for disability benefits is turned down, you may appeal the decision, in which case you may need to hire an attorney.