The Vocational Implication of Two Common Rheumatic Diseases

By Gordon, Phyllis A.; Stoelb, Matthew et al. | The Journal of Rehabilitation, January-March 1997 | Go to article overview

The Vocational Implication of Two Common Rheumatic Diseases


Gordon, Phyllis A., Stoelb, Matthew, Chiriboga, Jennifer, The Journal of Rehabilitation


With the passage of the Americans with Disabilities Act (ADA) of 1990, rehabilitation counselors and placement specialists have the potential to significantly augment employment opportunities for persons with chronic health conditions and disabilities. For persons experiencing chronic illness, successful rehabilitation will depend largely on counselors' understanding of issues pertaining to chronicity, specifics of disease patterns and progression, and appropriate accommodations that can be implemented. Of these chronic conditions, rheumatic diseases comprise a group of inflammatory joint (e.g., arthritis) and tissue (e.g., myositis) conditions affecting approximately 1 in 7 persons in the United States. They account for approximately 68 million work days lost and are one of the leading causes of work disability (Beardmore, 1993).

Therefore, two chronic rheumatic diseases, Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE), have been targeted for discussion due to their similarities on two counts: 1) both are similar in exhibiting symptoms of connective tissue diseases and 2) both are characterized as remitting-relapsing diseases with difficult diagnosis and unpredictable prognosis (Affleck, Tennen, Pfeiffer, & Fifield, 1987; Cornwell & Schmitt, 1990; Pollock, Christian, & Sands, 1990). In addition, both impact women to a far greater degree than men (Reisine & Fifield, 1988). This needs consideration as research suggests that women with disabilities typically experience higher unemployment rates than men with disabilities (dash, 1982; Britt, 1988). Despite the similarities, the two disorders do differ in significant ways as the prognosis for SLE is typically more negative and affects internal organs more severely than RA (Cornwell & Schmitt, 1990). Consequently, both similarities and differences will be highlighted regarding prognosis, pattern, and functional limitations.

Although ADA has the potential to significantly influence a rehabilitation counselor's role in promoting successful employment opportunities for individuals, much will depend on counselors' understanding of interventions related to reasonable accommodations and employment enhancers. The purpose of this article, therefore, is to discuss the medical, functional, and vocational implications of Rheumatoid Arthritis and Systemic Lupus Erythematosus as impediments to employment. Counseling and job placement strategies to enhance employability will be discussed.

Rheumatoid Arthritis

Rheumatoid arthritis is a systemic progressive disease falling under the general category of connective-tissue disorders. Although the exact cause of the disorder is not known, there has been much speculation about its etiology. At one time, it was believed that RA was a manifestation of psychological distress (Sheon, Moskowitz, Goldberg, & Hueter, 1987). At present, one common hypothesis is that this disorder is produced by alterations in immunological responses which cause antibodies to attack synovial membranes within the body (Jayson & Dixon, 1974). Incidence rates within the United States are estimated at between 1-2% of the adult population (Beardmore, 1993; Jayson & Dixon, 1974) making it one of the more common forms of arthritis (Garner & Kinderknecht, 1993). There is a three to one female to male ratio (Beardmore, 1993) with typical onset of the disease occurring most often between the ages of twenty and forty-five (Jayson & Dixon, 1974).

Medical Aspects

Rheumatoid arthritis is an insidious disease characterized by a persistent, but often slow, progression (Beardmore, 1993). RA causes recurrent inflammation of the synovial membranes of the joints (Falvo, 1991). Synovial membranes provide joints with vital fluids which help to maintain their functioning. As synovial membranes become overwhelmed by the body's own immunological agents, they become irritated and display swelling.

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