Is disability given for ankylosing spondylitis and which group?

Bechterew's disease (spondylitis with manifestations of ankylosis), which is also called Strumpell-Bechterew's disease, is a severe, practically incurable disease of the joints with a chronic course and rapid formation of scar (fibrous) tissue. The pathological process can involve not only the joints of the spinal column, but also joints consisting primarily of cartilage tissue, as well as paravertebral soft tissues, for example, muscles and tendons. The prevalence of this diagnosis in Russia is less than 1%, and most cases of peripheral arthritis (one of the main manifestations of ankylosing spondylitis) are detected in patients under 30 years of age. Approximately 80% of patients suffer from disability due to ankylosing spondylitis, since the disease has an aggressive course and is difficult to correct with medication.

Ankylosing spondylitis: disability

With no exceptions

There are situations in which disability is mandatory. As a rule, these include either pronounced manifestations of pathology or the presence of complications.

• Damage to the heart and aortic bulb by the pathological process.
• Bone destruction due to enthesitis.
• Development of Ig-A nephropathy or amyloidosis against the background of ankylosing spondylitis.
• Ischemic optic neuropathy.
• Restriction (more than 60%) or complete absence of movement in the hip joints due to arthritis.
• Significant reduction or absence of function of the temporomandibular joints.
• Spinal cord compression as a result of subluxation of the atlantoaxial joint.
• The occurrence of arachnoid diverticula of the spinal cord.
• The presence of a disease for 10 years that is resistant or difficult to correct with drug therapy.

The disability group assigned depends on the number of manifestations and the severity of their course.

How to get a disability group

The attending physician must inform the person suffering from ankylosing spondylitis that they are classified as disabled. However, quite often people independently ask the specialist leading questions. Only after this do they have the opportunity to ease working conditions and receive material benefits from the state. Disability for ankylosing spondylitis is assigned after a medical and social examination. The commission includes a number of specialists. These include a therapist, traumatologist, neurologist, vertebrologist, etc. During the research process, the patient is examined and interviewed, and the results of his tests are carefully studied. To assign a disability group, specialists must be provided with blood tests, radiography, computed tomography and magnetic resonance imaging, etc. Based on the listed studies, a person receives a disability group.

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In addition, one should take into account the fact that medical and social examination doctors study not only the characteristics of the patient’s illness, but also his financial condition. If a person is helped by relatives or has large deposits in a bank, he may be denied disability

In this case, the motivation is that the patient will not take advantage of benefits, but will provide himself with better drugs and use other treatment methods on his own. Of no small importance is the person’s ability to do his work. The patient must indicate all the details

If he does not work full time, is forced to ask for help from employees, or experiences psychological discomfort, he must definitely inform the experts about this. Otherwise, he may be refused to be assigned a disability or given an inadequate group. As a result of the examination, a person may be given temporary or permanent disability. Almost always, patients with this diagnosis are sent for re-examination and treatment in a hospital every 5 years. Based on the results of these measures, a decision is made to extend, remove or change the disability group. Permanent disability is assigned in the following cases:

If a person is helped by relatives or has large deposits in a bank, he may be denied disability

In this case, the motivation is that the patient will not take advantage of benefits, but will provide himself with better drugs and use other treatment methods on his own. Of no small importance is the person’s ability to do his work. The patient must indicate all the details

If he does not work full time, is forced to ask for help from employees, or experiences psychological discomfort, he must definitely inform the experts about this. Otherwise, he may be refused to be assigned a disability or given an inadequate group. As a result of the examination, a person may be given temporary or permanent disability. Almost always, patients with this diagnosis are sent for re-examination and treatment in a hospital every 5 years. Based on the results of these measures, a decision is made to extend, remove or change the disability group. Permanent disability is assigned in the following cases:

1. If a woman with such a diagnosis is 55 years old, and a man is 60 years old.
2. If the patient has group I or II disability for 5 years or more, subject to annual hospitalization and recovery in sanatoriums and no effect from treatment.
3. If a person has group III for more than 7 years with more frequent hospitalizations and lack of treatment results.

Ankylosing spondylitis is a very serious pathology that can lead to irreversible changes in the body. Pathological processes often become the basis for a person to become disabled. To determine its group, a medical and social examination is carried out, which takes into account all the features of the disease.

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When they are sent to prepare documents about incapacity for work

Registration of disability is possible if your illness is characterized by the following features:

• High speed of disease development;
• Recording repeated relapses of the disease with short breaks at an average rate of development of the disease;
• Acute attacks occur regularly, which are characterized by medium duration and a negative effect on other organs of the body, stimulating the development of other pathologies;
• If there are dysfunctions of the joints of the hip area or shoulders.

Criteria

Patients often ask whether they give disability for ankylosing spondylitis, and also what group will the state assign? For a more precise definition, it is necessary to consider all the categories that fall under the topic of this question. So, there are 3 groups of disabilities:

1. The third group is given if the patient loses the opportunity to work according to his profession. Moreover, it can be issued to someone whose activities are limited by strict boundaries. When diagnosing ankylosing spondylitis, category III disability can be given to a patient whose disease progresses at a slow pace with rare short-term relapses. In a patient receiving disability, skeletal functional impairments at the initial stage are recorded.
2. The second category of disability for ankylosing spondylitis is registered if the disease does not allow stable and full-time work in one’s profession. The exception to the rule is manual labor. This category is assigned to those affected by ankylosing spondylitis, whose pathology progresses quite strongly, and long-term (with short breaks) relapses are recorded. The skeletal condition of such a patient has functional impairment of 2-3 degrees, and the negative impact of the disease on the internal organs is noticeable. Often patients in this category have concomitant ailments such as heart, lung or kidney failure.
3. The first category of disability is issued to patients whose musculoskeletal system disorders have already reached irreversible or extremely severe consequences. Doctors record in patients of this group functional disorders of bone joints in the spine and other parts of the body, reaching grade 4. The disease leaves such patients firmly confined to bed or a wheelchair.

Tests and other diagnostic methods

If your general condition worsens and characteristic symptoms are detected, it is recommended to immediately consult a specialist (rheumatologist or vertebrologist). Only a doctor can make a diagnosis of ankylosing spondylitis based on the results of diagnostic studies.

To begin with, the doctor conducts an examination using palpation. This allows you to determine the exact location of the disease.

Instrumental diagnosis of ankylosing spondylitis consists of the following procedures:

• X-ray of the spine and hip joints. She shows signs of ankylosis formation,
• CT and MRI. With their help, you can notice changes in the joints and see the first signs of their disease.

After instrumental diagnostics, tests are taken for ankylosing spondylitis (general blood test and biochemical). A certain amount of hemoglobin, globulins and red blood cells indicates an inflammatory process (during an exacerbation of the disease).

A blood test for ankylosing spondylitis is taken in the morning on an empty stomach. These diagnostic methods make it possible to recognize ankylosing spondylitis at the initial stage.

What symptoms are the basis for diagnosis?

There is a certain set of symptoms, the appearance of which is the basis for a comprehensive diagnosis to identify ankylosing spondylitis (including differential diagnosis with rheumatoid arthritis). These symptoms include the following:

• pain in the area of ​​the sacrolumbar segment of the spine (irradiation to other parts of the body is uncharacteristic);
• stiffness and tension of the paravertebral muscles;

As the disease progresses, pain begins to spread not only to the lower back, but to the entire spine. With ankylosing spondylitis of grade 2-3, the patient may wake up at night from severe pain. The mobility of the affected joints is gradually limited, and ankylosing processes become more pronounced.

Important! With peripheral arthritis (damage to peripheral joints), the clinical picture can be manifested by pain in the ankles, knees and elbow joints. Some cases of ankylosing spondylitis are characterized by extra-articular symptoms, for example, chronic inflammation of the organs of vision, amyloidosis (a disorder of protein metabolism) or pathologies in the heart (heart rhythm disturbances, aortic valve insufficiency, etc.)

Where to go?

The fact that the patient is entitled to a disability group and certain measures of state support (including preferential medications, free treatment in a sanatorium) must be reported by the local doctor, usually a therapist. The patient is given a referral to undergo a medical commission, as well as an application form filled out in the name of the chief physician of the medical institution to which the patient is attached under the compulsory medical insurance policy. After this, the person needs to undergo a set of examinations and tests and receive a therapist’s conclusion, as well as collect a set of necessary documents with which to appear at the meeting of the ITU commission on the appointed day (the date is agreed upon in advance).

Getting a disability

List of documents

Before going to the commission, you should carefully check whether all the documents from the list have been collected (in most cases, copies of them are also required), since the lack of even one of them may be grounds for refusal to assign disabled status. The standard list of documents required to pass a commission at the Bureau of Medical and Social Expertise is as follows:

• application for examination, certified by the chief physician of the institution that issued the referral;

  
  Application to ITU

• passport and copies;
• referral to a commission;
• characteristics from the place of work containing complete information about the nature of the patient’s work activity and working conditions (sanitary and hygienic characteristics of working conditions);
• educational document (certificate, diploma, certificate of completion of courses, etc.);
• SNILS;
• an outpatient card from a local clinic (including extracts from medical documents, test results, a general practitioner’s report, various photographs);

  
  Outpatient card

• individual recovery and rehabilitation program with notes on completion of course therapy and treatment dynamics.

If a person applies to the commission again, he must also provide an existing certificate of disability.

Certificate of disability, example

Important! In cases where a patient is sent to medical examination to establish the fact of loss of professional ability to work, it is also necessary to provide reports on cases of occupational disease or industrial accidents (if any).

Simple assessment

Laboratory and instrumental research methods do not always make it possible to assess the real severity of the disease. An extremely important factor in obtaining a disability group from a medical and social expert commission is a person’s ability to cope with everyday tasks and take care of himself.

One of the methods for assessing a patient's ability to self-care is a special BASFI scale. The person is given a form on which only 10 questions are written. Next to the questions is a scale with 10 marks. The extreme values ​​correspond to the concepts of “easy” and “impossible”. The self-care ability score is based on the ability to perform some simple activities over the past week.

1. Put on socks or tights without assistance or without using any devices that facilitate this action.
2. Bend over a small object (pen, pencil), bending at the waist, provided that there are no auxiliary objects to perform this action.
3. Reach the top shelf with your hand without outside help or using auxiliary objects.
4. Stand up from a chair without using your hands for support, armrests, devices, or assistance.
5. Get up from the floor from a lying position without assistance or use of devices.
6. Stand in an upright position for 10 minutes without feeling discomfort, without resorting to the help of people or objects.
7. Climb up the stairs (12-15 steps) without leaning on the railing, using a cane. In this case, you need to put one foot on each step.
8. Look left or right by turning your head while keeping your torso stationary.
9. Physically active activity - exercises, gymnastics, gardening, sports.
10. The ability to be active throughout the day (at home or at work) without the need for rest.

This scale helps determine which group should be assigned to the patient.

The minimum score on the scale is 10 points, the maximum is 100. For answers whose score does not exceed 40 points, the assignment of disability is doubtful. A score of more than 40 points allows the patient to count on being assigned to a certain group (based not only on the score on the scale, but also on concomitant pathology).

Symptoms of the disease

At an early stage, the signs of the disease are quite difficult to recognize. Even with an X-ray examination, only highly professional and experienced doctors can identify symptoms.

In general, the signs of ankylosing spondylitis are classified based on the location of the inflammation.

Symptoms of joint damage:

The main symptom of the disease is considered to be an inflammatory process in the area of ​​the sacral joint. The patient usually feels deep pain in the gluteal muscles. Often this manifestation of the disease is mistaken for inflammation of the sciatic nerve, herniated intervertebral discs, or radiculitis.

Most often, patients experience damage to the shoulder and hip joints. In the morning hours there is severe pain and a feeling of stiffness.

In rare cases, the disease may last longer than this period.

Symptoms of spinal damage:

• At an early stage of the disease, the patient feels pain and stiffness in the lumbar spine. Typically, these symptoms may appear at night and become worse in the morning. To improve the condition, it is recommended to take a hot shower and do light exercise. During the daytime the pain usually subsides.
• If the disease develops, pain and a feeling of stiffness appear in the upper parts of the spine.
• The patient's physiological curves of the spine gradually smooth out, and stoop or kyphosis develops in the thoracic region. A person develops a specific posture. This period of the disease proceeds at a fairly slow pace over several years, with periodic exacerbations and remissions occurring.
• During the inflammatory process, the patient's back muscles in the spine area become painfully tense.
• If treatment is not started in time, fusion of the vertebral joints occurs, which leads to limited mobility and ossification of the intervertebral discs.

There are also other signs of the disease that are not related to the joints. 30 percent of patients experience:

• inflammation of the eyes in the form of damage to the vascular membranes, irises and ciliary body;
• Damage to the heart muscles, valve disease, myocarditis, inflammation of the aorta;
• Damage to the lower urinary tract, lungs and kidneys.

Description of the disease

Ankylosing spondylitis is a chronic inflammation of articular tissues mainly in the sacroiliac joints and spine.

It is accompanied by severe pain in the affected areas and, in the absence of proper therapy, can lead to ankylosis - pathological fusion of intervertebral joints and transformation of the spinal column into a single bone. This inevitably leads to a sharp limitation of mobility and muscle atrophy, and in particularly difficult, advanced cases – to a complete inability to move.

It affects mainly men (women are diagnosed with ankylosing spondylitis approximately 10 times less often), and at an active age - up to 30-35 years. The causes of the disease are still not reliably known. In modern medicine, the theory of autoimmune genesis of this disease and hereditary predisposition to it prevail.

Types of pathology and patient's condition

There are several types of ankylosing spondylitis that affect different parts of the body.
Obtaining a disability group depends on many factors. First of all, this is the patient’s condition, which differs in various forms of ankylosing spondylitis:

• in the central form, only the spine is involved in the lesion;
• with the rhizomelic form, the spinal column and hip and shoulder joints are affected;
• in the peripheral form, the spine and peripheral joints (knees, elbows, ankles, wrists) suffer;
• in the Scandinavian form, the lesion involves the spine, small joints of the hands and feet.

If a person develops central spondyloarthritis, severe impairment of trunk mobility rarely occurs. The rhizomelic form is characterized by significant impairment of mobility and rapid immobility. The peripheral and Scandinavian forms occur with a complete loss of the self-service function.

There is a primary chronic type of ankylosing spondylitis, which is characterized by slow progression (over 10-15 years) and no risk of complete ankylosis of the spinal column, as well as a recurrent one, which occurs with the rapid development of symptoms and complications.

Medical and social examination

Ankylosing spondylitis (Bechterew's disease) is a chronic systemic inflammation of the joints, sacroiliac joints and spine, its ligaments with a progressive tendency to ankylosis. The disease belongs to rheumatic diseases, since it is based primarily on connective tissue damage. The prevalence of ankylosing spondylitis in various countries ranges from 0.4 to 2%. Men get sick more often than women - ratio (5-9): 1.

It has been noted that ankylosing spondylitis occurs 2-6 times more often in family members in cases where the parents suffered from this disease. In most people, the disease develops at the age of 15-30 years, in 8.5% of people aged 10-15 years. After 50 years, the disease occurs extremely rarely. After 20 years of illness, 27% of patients become disabled, 73% of patients experience limited mobility, which forces them to change professions or reduce hours of daily work [Nasonova V.A., Ostapenko M.G., 1989]. The average age of disabled people suffering from ankylosing spondylitis is 44-47 years. The onset of the disease is associated with chronic inflammation of the synovium, similar to synovitis in RA. The disease begins with pain in the sacrum and spine in 75% of cases; in 20% - with pain in peripheral joints, and in 5% - with eye damage (iritis, iridocyclitis). Against the background of hereditary predisposition, genetic determination (the HLA B27 antigen complex is detected in 80-95% of patients), a certain role in the development of ankylosing spondylitis is assigned to infection that stimulates autoaggression, trauma, nervous and physical stress, dysfunction of the endocrine glands, and hypothermia. Subsequently, cartilage is destroyed and the process of ankylosis of the affected joints occurs. Damage to the intervertebral discs and vertebral bodies occurs as spondylodiscitis, accompanied by the formation of bone bridges along the edges of the vertebral bodies, giving the spine the appearance of a “bamboo stick”. The tendency to ankylosis is much more pronounced than in other forms of arthritis. Unlike RA, in patients with ankylosing spondylitis, rheumatoid factor is never detected in the blood, however, in the active stage of arthritis, patients experience an increase in ESR, a positive test for C-reactive protein and hyper-a2- and γ-globulinemia, increased enzyme activity— acid phosphatase and acid proteinase. Limitation of spinal mobility develops in two main ways: ascending - the process begins with damage to the sacroiliac joint and gradually spreads to the spine and ribs; descending - the process begins from the upper thoracic spine; it is rare. The cervical spine is involved in the process in half of patients 10 years after the onset of the disease. Complete ankylosis of the spine usually occurs no earlier than after 15-20 years.

Criteria for assessing work ability. There are four clinical forms of ankylosing spondylitis. The central form (damage to only the spine) occurs in 46.69 patients, rhizomelic (damage to the spine and “root” joints of the limbs - hip, shoulder) occurs in 17-18% of patients; peripheral (damage to the spine and peripheral joints - knees, elbows, ankles, wrists) occurs in 20-75% of patients; Scandinavian (damage to the spine and small joints of the hands and feet) is a type of peripheral form that is very similar to rheumatoid arthritis [Chepoy V.M., 1976].

The limitation of the patient’s life activity in a certain way depends on the clinical form of ankylosing spondylitis. In the central form of the disease, severe functional impairment is rarely observed, despite the development of severe kyphosis. With the rhizomelic form, mobility is significantly impaired and the patient quickly becomes immobilized. In the peripheral and Scandinavian forms, early manifestations of dysfunction of the hand and wrist joints end in loss of self-service elements.

According to the nature of the clinical course, two main types of ankylosing spondylitis are distinguished: primary chronic - characterized by a slowly progressive torpid course (complete ankylosation of the spine does not occur for 10-15 years) and recurrent, occurring with exacerbations, the frequency and severity of which are identical to the progressive form of RA. This is the most unfavorable type of ankylosing spondylitis. Frequent and prolonged exacerbations of the pathological process deprive patients of the opportunity to perform work in a production environment. Functional disorders in the spine and joints depend on the extent of the pathological process and the severity of the pain syndrome.

The course of the articular process can be acute (duration up to 3 months), subacute (6 months), protracted (9 months), chronic (more than 9 months).

Based on the degree of functional disorders of the spine and joints and the prevalence of the pathological process, for expert purposes three stages of ankylosing spondylitis are distinguished.

In stage I (early period of the disease), patients note inflammatory pain in the joints, lumbar region and sacroiliac joints, a feeling of stiffness in the lower back, especially in the morning, which is accompanied by rigidity of the lumbar muscles. Respiratory excursions of the chest are reduced to 3-4 cm (the norm is 6-8 cm). Stibora test - when bending, the arch of the spine is reduced by 2-4 cm and increases, it is 6-8 cm (the norm is 10 cm). Pavelky test - when turning the body, the length from the jugular notch of the sternum to the spinous process of L5 decreases by 2-3 cm and its increase is 5-6 cm (normal - 8 cm). On radiographs: signs of bilateral sacroiliitis (subchondral osteoporosis, unclear contours of the articulations with false widening of the joint space, focal periarticular osteosclerosis of the sacrum and iliac bones), partial ankylosis of the sacroiliac joints. Increased absorption of radionuclide (99Tc pyrophosphate) in the area of ​​the sacroiliac joints compared to the sacrum during scintigraphy before the development of radiological changes. Indicators of the activity of the process depend on the clinical form, type of disease, and the presence of HLA B27 antigen.

In stage II (the advanced period of the disease), immobility of the lumbar region, limitation of movements in the thoracic and cervical regions, radicular pain, pain in large joints, poor posture (round back - “native posture” or “straight plank back”), tension in the back muscles or their atrophy. The type of breathing is abdominal, with a transverse fold on the abdomen. The respiratory excursion of the chest is reduced to 2-3 cm. With the Slibora test, the arc of the spine decreases when bending by 5-6 cm and the increase is 4-5 cm. With rotational movements of the spine, the length between the measured points decreases by 4-5 cm compared to the norm and its increase is 3-4 cm. X-rays of the spine reveal characteristic changes: complete obliteration of the sacroiliac joints, partial or complete ankylosis in the true joints of the spine, in the costovertebral and sternocostal joints, arthritis of the hip and knee joints.

Stage III (terminal) is characterized by a forced body position, a rounded back, atrophy of the muscles of the shoulder pelvic girdle, and a sunken chest. There are no movements in all parts of the spine. Respiratory excursion of the chest up to 0.5 cm. Breathing becomes shallow and frequent. The vital capacity of the lungs decreases sharply. X-ray: the spine appears in the form of a “bamboo stick” with ossification of the entire ligamentous apparatus of the spine, periosteal phenomena in the area of ​​the ischial tuberosities, heel bones, and often ankylosis of large joints. Along with changes in the spine in stages I and II of the disease, there is eye damage in the form of iritis or iridocyclitis in 10-30% of patients, damage to the cardiovascular system (pericarditis, aortitis) in 20-22% of cases, damage to the nervous system (secondary lumbar thoracic, cervical radiculitis). In stages II and III, kidney damage (urolithiasis, amyloidosis) is noted in 31% of patients and lung damage as a result of limited respiratory mobility of the chest, which contributes to the development of respiratory diseases and tuberculosis.

Treatment of ankylosing siondylitis is based on the same principles as RA, and should be systematically long-term and adequate to the activity and severity of the disease. In the late stage of the disease, when the hip joints are affected, endoprosthesis replacement is indicated (to improve self-care). Clinical examination of these patients allows for systematic anti-inflammatory therapy to prevent exacerbations, preserve spinal function and general performance. During periods of remission, radiography of the joints and spine is performed once a year.

The criteria and approximate terms of VUT are similar to those for RA (clinical and laboratory characteristics of exacerbations of the disease, confirmed by activity indicators of degrees II and III. The duration of VUT, depending on the severity of exacerbations and the effectiveness of therapy, ranges from 40 to 90 days. For frequent and prolonged exacerbations, treatment according to sick leave should not exceed 4 months with subsequent referral to medical examination.

Criteria for the restoration of temporarily lost ability to work: a stable decrease in activity to grades 0 and 1, absence or moderate pain, dysfunction of the affected joints no more than grade 2. For persons working in contraindicated types and working conditions, the necessary restrictions are determined in accordance with the conclusion of the CEC of medical institutions.

Contraindicated types and working conditions: - work associated with heavy and moderate physical labor; - labor associated with forced body position, frequent bending, and vibration of the body; — work in unfavorable meteorological conditions (in hot shops, with high humidity, gas pollution); — in peripheral and Scandinavian forms of the disease, work that requires precise and small movements with prolonged standing is contraindicated.

Indications for referral to ITU:

- recurrent, rapidly progressing type of disease (no remission for more than a year);

- a slowly progressive type of disease with frequent, moderate frequency and duration of exacerbations, damage to other organs and systems;

— primary chronic type of disease of stages I and II in the presence of contraindicated types and working conditions and the impossibility of rational employment;

— Stage III of the process;

- rhizomelic form with severe and pronounced dysfunction of the shoulder or hip joints.

The required scope of diagnostic examination methods when referring to MSE should be the same as for RA.
CRITERIA FOR DISABILITY FOR BECHTEROW'S DISEASE IN ADULTS IN 2020 Disability is not established if the patient has: - a minor impairment of body function; minor dysfunction of the spine and/or joints; absence or low degree of disease activity; FC I; absence of extraskeletal manifestations of the disease; absence of complications of the disease and/or therapy. Disability of the 3rd group is established if the patient has: - moderate dysfunction of the spine and/or joints, with a remaining moderate or high degree of disease activity; FC II; the presence of extraskeletal manifestations of the disease with moderate impairment of body functions; absence of complications of the disease and/or therapy. Group 2 disability is established if the patient has: - severe dysfunction of the spine and/or joints, with moderate or high disease activity remaining; FC III; the presence of extraskeletal manifestations of the disease; the presence of complications of the disease and/or therapy; leading to severe dysfunction of the body. Disability of the 1st group is established if the patient has: - significantly expressed dysfunctions of the body, significantly expressed dysfunctions of the spine/joints; FC IV; the presence of extraskeletal manifestations of the disease; the presence of complications of the disease and/or therapy leading to significant impairment of body functions. CRITERIA FOR DISABILITY IN CHILDREN'S BEKHTEREV'S DISEASE IN 2021 Disability is not established if the child has: - absence or minor dysfunction of the joints and/or spine; radiographic stage I, no disease progression; absence or presence of exacerbations (no more than 1 time per year), absence or I degree of activity of the inflammatory process during therapy; FC I; no complications of the disease from drug therapy (NSAIDs). The category “disabled child” is established if the patient has: - moderate dysfunction of the joints and/or spine (FC II degree);
radiographic stage II; progressive course of the disease: exacerbations 2 - 4 times a year, continued activity of the inflammatory process of I or II degree against the background of immunosuppressive therapy; the need to adjust therapy, the possibility of achieving remission only with the use of immunosuppressive therapy with drugs from several (2 or more) pharmacotherapeutic groups (except for NSAIDs), including genetically engineered biological drugs; the presence of complications of the disease and ongoing drug therapy. - severe disturbance of static-dynamic function due to damage to the joints and/or spine; radiographic stage II or III; progressive course of the disease; frequent long-term exacerbations (more than 4 times a year), FC II or III; continued activity of the inflammatory process of 2 or 3 degrees against the background of immunosuppressive therapy; the possibility of achieving remission only with the use of immunosuppressive therapy with drugs from several (2 or more) pharmacotherapeutic groups (with the exception of NSAIDs); including genetically engineered biological drugs; the presence of complications of the disease and ongoing drug therapy. — significantly pronounced disturbances of static-dynamic functions caused by damage to the joints and/or spine; radiographic stage III or IV; rapidly progressing course of the disease; activity of the inflammatory process of 3 degrees; FC III or IV; low efficiency or resistance to ongoing immunosuppressive therapy with drugs from several pharmacotherapeutic groups (2 or more, including genetically engineered biological drugs); the presence of irreversible complications of the disease and ongoing drug therapy. A patient can receive an official conclusion on the presence (or absence) of grounds for establishing disability only based on the results of his examination at the ITU bureau of the corresponding region

.
The procedure for completing documents for undergoing MSE (including the algorithm of actions in case of refusal of attending physicians to refer a patient to MSE) is described in sufficient detail in this section of the forum: Registration of disability in simple language
Source

What diseases give you disability in 2021?

• complete paralysis of the organs of movement;
• blindness or deafness;
• complex nervous disorders;
• deformation of the arms or legs;
• insurmountable dysfunction of some internal organ.

Hint: the first category means that a disabled person is practically unable to care for himself without the help of relatives or social workers.

The list of violations for which a group is assigned to a child is quite wide. It includes almost all ailments from the first list. The attending doctor should understand the situation more specifically. And the responsibilities of parents include regular visits to the pediatrician in order to prevent the development of negative processes in the baby’s body.

Procedure for issuing a certificate

A certificate for a disabled person is issued by a specialized government agency - the medical and social examination (MSE). Before contacting the organization:

• treatment in a regular clinic at the place of registration;
• carrying out activities to prepare documentation.

Attention: ITU goes to the patient’s place of residence if the latter is unable to visit the government agency. The procedure for applying for help is as follows:

The procedure for applying for help is as follows:

The work of medical and social examination

The responsibilities of the government agency include confirming the final diagnosis and issuing the coveted certificate about the group. The decision is made only after studying all the nuances of the situation. For the applicant this means the following:

1. His documents will be subject to scrutiny. Each certificate will be examined for accuracy.
2. Civil servants will analyze the correctness of:
   making a diagnosis;
3. treatment assignments;
4. use of medications.
5. The patient will be invited for an interview. During its course:
   a visual inspection is carried out;
6. the person’s social status, including family status, is clarified.
7. The examination will probably require an inspection report of living conditions. Finding sites with a license to play online slots is not so easy. There is a casino table with withdrawal of money to a card and this is a really accessible option for comparing information and parameters that will allow you to draw appropriate conclusions. Playing in a casino with withdrawal is quite simple. It is done by social workers.

Upon completion of all required activities, the commission makes a decision. It could be:

• positive - the establishment of a specific group;
• negative if there are no sufficient grounds.

The applicant is given a certificate. The paper states:

• disability category;
• degree of disability;
• date of re-examination.

Important: you cannot skip the next examination, as the disability is canceled automatically. And this leads to a stop in the provision of appropriate benefits and payments.

Is it possible to be denied disability?

After studying all the materials, the commission may come to the conclusion that the applicant does not need to be assigned a special status and associated benefits.

The main reasons for refusal are:

• Absence of serious disturbances in the functioning of the body;
• High degree of financial well-being.

What to do if you refuse

A negative decision of the commission can be appealed in two ways:

1. Request a re-examination;
2. Go to court.

To repeat the examination, you need to write a statement expressing your disagreement with the decision received and demanding its revision. If the re-examination does not bring the desired result, the only option left is to go to court, which is the last resort. The resulting court decision is not subject to appeal.

Application form for appeal

Sample statement of claim

Causes

Ankylosing spondylitis manifests itself in different ways. In some patients the disease is particularly aggressive, in other cases the disease is so mild that it is never clearly diagnosed. In some, the joints of the limbs are affected; in others, the kidneys, heart and other organs are affected. The degree of disability may be influenced by targeted therapy and patient behavior.

The “typical” course of the disease is characterized by:

• Onset of the disease between the ages of 15 and 35 years;
• Temporary exacerbations and improvements;
• Progressive deformation of the spine, especially in the first 20 years;
• Ankylosing of joints;
• Degeneration of the iris.

Onset before age 15 is often considered a sign of serious illness. A survey among patients with AS showed that in the early onset of the disease the probability increases slightly.

Inflammatory spine disease can also occur together with psoriasis or chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis). In these cases, doctors talk about psoriatic or enteropathic spondyloarthritis. Reactive arthritis is spondyloarthritis that occurs after a bacterial infection. Diseases associated with ankylosing spondylitis (and also those with the genetic factor HLA-B27) are combined into the group of spondyloarthritis.

Psoriasis

Nine out of ten patients with ankylosing spondylitis are independent of external care, even after 40 years of illness. Painful relapses can come and go for a long time, but eventually the inflammatory phase of the disease usually calms down. However, experience shows that physical therapy exercises and drug therapy can prevent severe spinal curvature in most cases.

Osteoporosis may occur in the later stages of the disease. Physical therapy is also important

Because a stiff and porous spine is prone to vertebral fractures, older patients need to be especially wary of seemingly harmless accidents and take appropriate precautions. Not only in case of accidents, but also during artificial respiration during anesthesia, care must be taken

In the initial stage, symptoms are usually non-specific and therefore often misinterpreted. However, today there are criteria based on which experienced rheumatologists can make a reliable diagnosis. New magnetic resonance imaging capabilities are also making diagnosis easier. It often takes several years between the first symptoms and a confirmed diagnosis.

The following symptoms are characteristic of the early stage of ankylosing spondylitis:

• There is pain between the right and left buttocks, which often radiates to the thigh;
• The pain disappears with rest (the opposite is true for non-inflammatory back diseases);
• Symptoms persist for more than 3 months;
• Onset of disease before age 40;
• The onset of stiffness and pain, especially in the early morning.

In addition to these common first symptoms, the following criteria may also indicate spondyloarthritis:

• Asymmetric inflammation of individual joints (for example, hip, knee);
• Leg pain or enthesitis;
• Inflammation of the iris (iritis) in the eye;
• Disappearance of pain after taking a non-steroidal anti-inflammatory drug for 50 hours.

Detection of the HLA-B27 genetic trait does not confirm the presence of spondyloarthritis. Also, the absence of a genetic trait does not prove that ankylosing spondylitis does not exist. The finding gives the doctor additional information about whether the patient may have AS. The presence of the hereditary factor HLA-B27 increases the likelihood of developing AS.

How to get a disability group

According to the law, the attending physician must tell the patient that the patient is classified as a disabled person. However, quite often patients themselves ask leading questions to their doctor and only then do they have the opportunity to make their work easier and receive financial benefits from the state. Determines the ITU disability group (medical and social examination). Several doctors are present at this examination - a vertebrologist, a therapist, a neurologist, a traumatologist, etc. During the commission, the patient is interviewed and examined, blood tests, X-rays, CT, MRI, and extracts from the medical history card are carefully studied. Only on the basis of these data the patient receives a disability group.

You should also take into account the fact that doctors and ITU experts examine not only aspects of the patient’s disease, but also his financial security. If the patient claims that his relatives help him or he has large bank deposits, then most likely he will be denied disability, citing that he will not use his benefits, providing himself with better medicines and other methods of treating his disease.

The ITU may also focus on the patient's ability to do their job. If the patient does not disclose the fact that he does not work full-time, often asks for help from employees and superiors, but simply tries to psychologically support himself and tells the doctors that he is completely coping, there is also a risk that the disability group will be denied or his group will be denied not true. Such nuances of questions should be taken into account and be extremely careful during the examination.

The patient's disability may be temporary or permanent. These criteria are also decided at the ITU. Almost always and in all cases, every 5 years the patient is sent for re-examination of the disease and for inpatient treatment, to extend the group or remove it, or to change it.

Criteria for permanent, indefinite disability:

• If the female patient is 55 years old and the male patient is 60 years old;
• If the patient has disability group I or II for 5 years or more, if annual hospitalizations and rehabilitation were carried out in sanatoriums, dispensaries and specialized departments of hospitals, treatment in which was unsuccessful;
• If you have disability group III for 7 years or more with regular hospitalizations and rehabilitations that did not produce a therapeutic effect.

Do they give you disability?

Strumpell-Bechterew-Marie disease is a chronic pathology with a progressive course, so any treatment is aimed at improving the quality of life of such patients and slowing down further damage to the joints. Ankylosis (immobility of joints) is a severe complication of this disease, which significantly limits a person’s ability to engage in sports, professional and creative activities and is the basis for obtaining the status of a disabled person.

Ankylosis of the vertebrae on x-ray

Permanent (indefinite) disability for this disease is not given immediately. Before it is assigned, the patient must undergo annual hospitalization for 5 years, as well as outpatient therapy (with regular monitoring, including monitoring) and treatment in a day hospital (if necessary). In some cases, the patient may be sent to a sanatorium-resort rehabilitation treatment, which is necessary to achieve stable remission and slow down ankylosing processes - fusion of joints with the formation of osseous-connective or fibrous replacement tissue, leading to immobility of the damaged musculoskeletal segment.

To obtain disability, the patient must undergo annual hospitalization for 5 years, as well as outpatient therapy

If no positive dynamics are identified within five years, or the disease progresses rapidly, the person is assigned disability indefinitely. Until then, the MSE (medical-sociological or medical-social examination) will be carried out annually, and its results will determine not only the fact of assigning a group, but also the amount of disability benefits, as well as the list of entitlements.

Important information

1. Intervertebral hernia provides grounds for receiving benefits. However, the patient is referred for examination only after long-term treatment. And then only if it does not show positive dynamics.
2. Diabetes mellitus is directly included in the list of the Ministry of Health and Social Development. If there is such a metabolic disorder, you should confidently seek a referral. The category of disability will be determined during the examination.
3. The consequences of a stroke also lead to the patient being recognized as disabled. According to statistics, only one person out of five recovers. Everyone else becomes beneficiaries.
4. Vision problems are a special case. When examined by a doctor, I find out the possibility of recovery. And it depends on the reasons for the loss of vision. Therefore, such a disease is dealt with individually. If cure, including through surgery, is impossible, then a group is given.

We describe typical ways to resolve legal issues, but each case is unique and requires individual legal assistance.

Disability and life prognosis

Ankylosing spondylitis, in the absence of effective treatment, will progress, reducing the function of the spinal column. Complications of ankylosing spondylitis include the occurrence of serious diseases. Amyloidosis occurs in 25% of affected people, which leads to kidney failure.

Since the disease affects the cardiovascular system, shortness of breath becomes more frequent over time and arrhythmia occurs. Many patients experience eye damage, which manifests itself as iridocyclitis. There are cases when, against the background of decreased chest mobility, patients developed pneumonia.

When preventive measures are taken, a diagnosis of ankylosing spondylitis has a favorable prognosis for life. It is impossible to say reliably how many people live with ankylosing spondylitis, since everything depends on the individual characteristics of the body, the nature of the course of the disease and accompanying ailments.

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Which group is determined by patients with ankylosing spondylitis?

What specific disability group a patient diagnosed with ankylosing spondylitis will receive depends not only on the stage of the inflammatory-destructive process, but also on the degree of disability and ability to self-care. The task of the commission is to determine whether the patient can continue to work in his position, whether the working conditions correspond to his illness, and whether there are opportunities for adequate social adaptation of the patient. The panel will also assess the person's ability to perform self-care activities (hygiene, dressing, eating, ambulation) and dependence on assistance from others and family members.

Criteria for determining disability

Important! The patient’s financial situation, whether he has large deposits or a permanent source of income are also taken into account.

Bechterew's disease disability part 1

10/23/2011 by Victor Gromakov

Hello dear friend.

Today we have the topic of ankylosing spondylitis and disability. This topic is practically a continuation of the topic of ankylosing spondylitis prognosis and ankylosing spondylitis diagnosis. In the topic of prognosis, I touched on disability a little, now let’s look at this topic a little more broadly.

Patients diagnosed with ankylosing spondylitis are in most cases forced to attend a group due to limited movement and prolonged pain. The period for determining disability depends mainly on two factors. Depending on the form of ankylosing spondylitis and the type of course of the disease.

The central form of ankylosing spondylitis, although it is more common than others, does not provide strong restrictions and contraindications to work, especially at the initial stage of development. But the rhizomelic form of ankylosing spondylitis causes significant stiffness and loss of mobility; the hip joints and shoulder girdle are affected.

Peripheral and Scandinavian forms of ankylosing spondylitis, with a progressive course, give early restrictions in the small and wrist joints, which leads to the loss of the patient’s ability to care for himself.

The course of ankylosing spondylitis is divided into two types.

Primary chronic is characterized by slow progression of the disease, and can last 10-20 years without complete ankylosis.

The second type is recurrent, accompanied by frequent and prolonged exacerbations of the disease, and stiffness of the spine and joints.

When assigning disability, attention is also paid to the stage of the disease. There are three of them

First stage (initial period). Usually accompanied by inflammation and pain in the lower back and joints. There is also severe stiffness in the lower back in the morning. Breathing is limited due to poor chest mobility.

Second stage (advanced period of the disease). It is characterized by immobility of the lumbar spine, and severe limitations of mobility in the thoracic and cervical spine, with partial or complete ankyolization of the spine and large joints. There is constant pain in the hip joints and shoulder girdle. There is a noticeable curvature of the spine and severe tension of the back muscles, or their atrophy. The chest's mobility is even more limited, and patients breathe mainly from the stomach.

The third stage (terminal period of the disease), when the process becomes irreversible. The spine and often large joints are affected by ankylosis. The spine is rigid, the chest is sunken and almost immobilized, there is constant pain. Also at this stage, kidney diseases, heart diseases, and lung diseases occur due to the immobility of the chest.

That's all for today. To be continued in the next issue.

All the best.

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Symptoms of the disease

The lower back begins to bother you, especially during sleep

Ankylosing spondylitis affects mainly men, and at the most working age - the first symptoms appear between 15 and 30 years. At the same time, the pathology is constantly progressing, so by the age of 35-40 a person is faced with severe disorders in the functioning of the spinal column and joints.

With ankylosing spondylitis, a chronic inflammatory process occurs in the intervertebral discs, joints and tendons. This leads to disruption of the nutrition of these skeletal structures, due to which the space between the vertebrae decreases as salt deposits occur. This is a long process, but it inevitably leads to impaired mobility of the spine or its deformation (scoliosis, kyphosis).

The symptoms of the disease are as follows:

• loss of strength, decreased performance;
• night pain in the lumbar spine;
• pain in the hip joint, radiating to the groin and buttocks;
• stiffness of movements after a long stay in one position;
• rachiocampsis;
• violation of movement coordination;
• damage to other organs and systems.

In addition to the fact that ankylosing spondylitis slowly affects the joints, disrupting their motor function, it can also lead to disorders of the cardiovascular system, kidneys, lungs, and urinary tract. Patients with this diagnosis often experience myocarditis.

Since there is no effective way to treat ankylosing spondylitis, almost all patients who have been living with this disease for a long time are registered for disability. Having figured out whether men are given disabilities due to ankylosing spondylitis, we should dwell in more detail on the process of its registration.

Registration of disability for ankylosing spondylitis

I was diagnosed with ankylosing spondylitis, and in order to get a group they said I had to wait half a year, is this what a group with my disease is supposed to be? Thank you. Litvinenko Oleg Anatolievich

Hello Oleg Anatolievich! As a rule, when diagnosed with ankylosing spondylitis (or ankylosing spondylitis), the patient is asked to register for disability at the stage of moderate damage (moderate limitation of movement in the spine or in peripheral joints) and, naturally, at a late stage (significant limitation of movement in the spine or large joints due to the development of their ankylosis).

The disability group is determined by the clinical form of the disease, the degree of activity of the inflammatory process, the presence and severity of systemic manifestations, the functional ability of the joints and spine, as well as decreased ability to work.

Using special techniques, doctors evaluate how disorders affect various aspects of a person’s life: ability to self-care, work, professional activity, ability to move, orientation, etc.

Draw your attention to! When making a decision, medical and social examination staff (MSE) evaluate not the dysfunction of a single part of the body, but the functions of the body as a whole. Believing that the human body is so intelligently designed that, often, in the presence of pathology in one organ, the paired organ compensates for its functions

But do not forget that compensation reserves are not unlimited...

To register a disability, you must be registered with a rheumatologist. If there are grounds, the doctor draws up Form 088 to submit documents to MSEC. Then, according to the usual scheme: ITU employees study the submitted documents, certificates confirming medical indications for registration of disability, prescribe the necessary examination and make a decision to recognize you as disabled or to refuse to register disability.

The procedure for obtaining disability in the Russian Federation is determined by Decree No. 95 of February 20, 2006. “ON THE PROCEDURE AND CONDITIONS FOR RECOGNIZING A PERSON AS DISABLED” https://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=58610;div=LAW;mb=LAW;opt=1 ;ts=0447640A7A01B06B9CC0D4DAF4102C8C.

Note! The chances of receiving disability increase if there are extracts from hospitals where the patient was treated. Therefore, do not refuse to be referred to a hospital, especially a specialized one.

You can read more about the disease itself here https://med-tutorial.ru/med-books/book/21/page/6-glava-5-bolezn-behtereva/, or https://www.behterev.info/ #sele.

· https://www.domotvetov.ru/medicine/a/41039_104.html

· https://www.domotvetov.ru/medicine/a/43184_90.html

· https://www.domotvetov.ru/medicine/a/38690_104.html

Helpful advice?

Attention!

We remind you that the article is advisory in nature. To establish the correct diagnosis, you need a face-to-face consultation with a doctor!

Examinations for disability

Did you know that...

Next fact

The presence of disability and its degree are determined by a medical and social examination (MSE).

The attending physician refers the patient to MSE if the disease has reached certain indicators:

• rapid development of the disease and lack of remission within 1 year;
• slow development of the disease with prolonged and serious exacerbations, spread of the process to other organs;
• severe disorders of the spine and joints, immobility, difficulty breathing.

Check out the list of required tests to pass the ITU commission. The ITU commission considers the following tests and examinations:

• General blood analysis.
• Blood for ESR, protein, protein fractions.
• X-ray of the spine.
• or MRI of the spine.
• Outpatient card with a description of the patient's complaints and course of illness.
• Extracts from hospitals.
• Extracts from sanatoriums (if available).

Pension and benefits

After registration of status, the patient is entitled to a number of benefits and financial payments. Their size differs depending on the resulting group.

Table of required payments and benefits

To process payments in connection with obtaining the status of a disabled person, you must contact the local Pension Fund, where you can present the ITU decision and identification documents.

How and what group can I get?

The attending physician should be the first to speak about determining disability. He has all the data to make a decision on the further steps necessary for the patient to obtain disabled status.

Sometimes patients take the initiative and ask the doctor relevant questions. This is mostly due to the fear of getting less than what they consider necessary for themselves, or even not getting it at all.

As a rule, we are talking about a group. If the third is even popularly called “working” (this means that the patient is given a temporary disability during which he can perform certain types of activities), then the second and first clearly mean a ban on work.

These two groups are established in the following cases:

• the patient has been diagnosed with the third group of disability for seven or more years, there are no treatment results and periods of hospitalization are becoming more frequent,
• the patient is at the age of cessation of active work (for women this is 55 years old, for men 60).