Inflammatory arthritis is a broad term for several distinct arthritic conditions which, when severe, can result in disability. In general, inflammatory arthritis falls into the autoimmune category of illnesses. The Commissioner specifically identifies a few of the disease which falls into the inflammatory arthritis category in her description of Listing 14.09 at 14.00 (D)(6). These diseases include rheumatoid arthritis; inflammatory bowel disease; psoriatic arthritis; gout and pseudogout; Lyme disease; ankylosing spondylitis; Whipple’s disease; Bechet’s disease and Reiter’s syndrome.
A diagnosis of an inflammatory arthritic condition is made by a combination of clinical evaluation with blood tests. As to the specific test results from both the clinical examination and the blood test, the Social Security Administration defers to the medical material published by the Arthritis Foundation. The Social Security Administration does not limit the physician who can make a diagnosis of any of the diseases which make up the family of inflammatory arthritis to be a specialist (i.e., a rheumatologist). It appears that Social Security will accept the diagnosis of a primary care physician as well as a specialist. The critical part of the determination is not the type of physician who makes the diagnosis but whether the diagnosis is supportable by medically acceptable, diagnostic techniques.
Inflammatory arthritis focuses on the effect of the joints in the presence of one if the autoimmune diseases listed above. The joint could be a major weight-bearing one or non-weight bearing. As the name suggests, inflammation or swelling is present in the joints. In addition to inflammation, there is the presence of pain. It is anticipated that the inflammation results in loss of function (for example in the ability to walk or to use hands and fingers).
Ankylosing spondylitis is an inflammatory arthritic condition which affects the vertebrae of the back. It causes swelling between the vertebrae. Sometimes, the vertebrae are in the neck or mid-back area and result in a type of fusion causing stiffness and an inability to move. When that happens, Social Security will find that the person is able to walk has been impacted even though that person is not required to use canes or walkers. Instead, the walking issue must do more with the lack of an ability to turn from side to side or turn his/her neck to see.
Social Security recognizes that an inflammatory arthritic condition may involve inflammation system or organ issues outside of the inflamed joints. This event is known as extra-articular manifestations. These systems or organs may be in the skeletal system, the eyes, the lungs, the heart, the kidneys, the spine, the immune system, and the mental system, to name a few.
Finally, Social Security recognizes that inflammatory arthritis may cause an increase of constitutional signs including weight loss, malaise, fever, and severe fatigue.
In order to meet or equal Listing 14.09, one of four requirements must be satisfied: the person has inflammatory arthritis which affects a weight-bearing joint making in ineffective to walk or another joint making in ineffective to finger or handle; or inflammatory arthritis with involvement of two systems and two constitutional symptoms; or ankylosing spondylitis to the degree specified in the Listing; or inflammatory arthritis (with repeated manifestations), two constitutional symptoms and a limitation to to a marked level in one: activities of daily living; maintaining social functioning; deficiencies in concentration, persistence or pace.