Selected Immune Disorders and Disability (2022) / Chapter Skim
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administers the Social Security Disability Insurance program and the Supplemental Security Income program. Those programs provide disability benefits to individuals who qualify due to a disability.
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5. For the immune system disorders identified in task 1, identify to the degree possible the functional limitations associated with each disorder, including physical functioning limitations, mental function
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Three overall characteristics are notable among the immune disorders that the committee studied: their systemic and heterogeneous nature, their cyclic and unpredictable disease course, and the effects of their treatment. First, immune disorders are systemic diseases with heterogeneous symptoms that involve multiple organ systems and commonly also involve 1 M
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Instead, the goal of treatment is to have the lowest degree of disease activity to prevent or limit organ damage. Functional impairment is usually due to active inflammation or organ damage and can result from multiple systemic effects 2 While it is customary in medical terminology to refer to "functional impairment," SSA distinguishes between impairments (which are the diagnosable medical conditions)
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Careful monitoring of glucocorticoid therapy, combination therapy, and the addition of drugs to treat multiple systemic effects may be indicators of a more severe disease. Additionally, the use of intravenous glucocorticoids and cyclophosphamide may indicate acute and severe decompensation of a newly diagnosed or underlying immune disorder.
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Most severe flares follow a moderate flare in the same organ system, and about one in five severe flares will manifest with new organ involvement or worsening of major organ disease. Treatment depends on the organ systems involved, and despite advancements in SLE treatment and a better understanding of the disease, patients have significant morbidity and mortality.
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Patients with systemic sclerosis may develop functional impairment due to skin thickening, small and large joint contractures, inflammatory arthritis, tendon friction rubs, myositis, digital ulcers, GI dysmotility, and dyspnea from cardiopulmonary complications. Skin thickening, joint contractures, synovitis, and digital ulcers in particular may contribute to hand disability.
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and cancer are rarer, while GI, endocrine, and vascular effects are more common. Functional disability is common in individuals with myositis, particularly impaired muscle function, predominantly in the proximal and axial muscle groups, that results in functional limitations related to muscle weakness and decreased endurance with more fatigability.
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Even if the disease is controlled, patients are often left with damage such as calcinosis, muscle atrophy with fatty replacement leading to permanent weakness, and decreased endurance. Corticosteroids with adjunctive steroid-sparing immunosuppressive therapies are recommended to treat disease activity, prevent mortality, and reduce long-term disability.
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In patients with longstanding and severe disease, persistent synovial inflammation will result in the erosion of cartilage and bone, leading to joint destruction and deformities, which in turn cause chronic pain and functional limitations. The goal of RA treatment is to attain and maintain control of disease activity in an effort to reduce the symptoms of joint pain and swelling, prevent deformity, maintain quality of life and function, and limit extra-articular disease manifestations.
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There are no treatments to cure SS, and treatment research lags behind that of other autoimmune disorders. Management involves improving quality of life by reducing dryness, fatigue, and chronic pain, and by treating systemic manifestations to prevent damage accrual, which will worsen the vital and functional prognosis.
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12 SELECTED IMMUNE DISORDERS AND DISABILITY is not known if juvenile SS is an early presentation of adult-type disease or if it is a different entity, as is the case for other autoimmune diseases. Differences in presenting symptoms between children and adults suggest it is the latter.
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