Arthritis is the number one cause of disability in the United States, making up nearly 20 percent of all disabilities among people aged 15 and over. An estimated 43 million Americans are affected by the disease. Many face work-related physical limitations. The total cost of arthritis, including medical care and lost productivity, is nearly $65 billion per year.

It is important to note that there are more than 100 different types of arthritis, each producing different symptoms and levels of impairment. Some of the most common forms of arthritis include osteoarthritis, rheumatoid arthritis, fibromyalgia, and lupus.

Osteoarthritis, often called degenerative arthritis, involves the breakdown of bones and cartilage, causing pain and stiffness. Osteoarthritis commonly affects the movement and function of fingers, knees, feet, hips, and back.

Rheumatoid arthritis is an abnormality in the immune system causing inflammation of the lining in the joints and/or internal organs. Rheumatoid arthritis often affects the same joints on both sides of the body and can affect the hands, wrists, feet, knees, ankles, shoulders, neck, jaw, and elbows. The disease may also cause inflammation of internal organs, leading to significant organ damage. Individuals with rheumatoid arthritis are likely to experience times when they have few symptoms and other times when they have very severe symptoms causing significant limitations.

Fibromyalgia has become a more common diagnosis during the past several years. It is a condition that affects muscles and their attachments to bone and is characterized by widespread pain, fatigue, stiffness, sleep disturbance, and psychological distress.

Lupus is a rheumatic disease affecting skin and body tissue. Additionally, some people experience involvement of organs such as kidneys, lungs, or heart. Lupus is generally diagnosed between age 18 and 45. Symptoms include skin rashes, abnormal sun sensitivity, and joint pain, inflammation, and stiffness. Lupus is treatable, but can be a very serious impairment. Individuals with lupus will experience flares and remissions. A flare is a period of worsening symptoms. A remission is a period with few or no symptoms of the disease.

Regardless of the specific diagnosis, individuals with arthritis need appropriate rest and exercise. It is important that they learn to pace their activities and maintain appropriate self-care skills to minimize pain and functional loss. With reasonable accommodations from employers, many people with arthritis continue to be productive employees.

Many people with arthritis would meet the definition of an “individual with a disability” under the Americans with Disabilities Act (ADA). Under the ADA, an individual with a disability is a person who: has a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment, or is regarded as having such an impairment.

An impairment is substantially limiting if it prevents or significantly restricts the performance of a major life activity. The nature, severity, duration, and long-term impact of the condition are all factors that go into determining whether an impairment rises to the level of an ADA disability. Mitigating measures, such as medication, must also be considered. Thus, if an individual’s arthritis is completely or substantially controlled with medication all the time, s/he would not be considered to have an ADA disability because the condition does not substantially limit a major life activity.

The ADA does not cover impairments that are relatively minimal in nature and severity or that are considered short-term (e.g., mild arthritis in a finger causing only occasional discomfort). Many forms of arthritis (e.g., rheumatoid, lupus) can be controlled with proper treatment. However, even when properly treated, an individual with arthritis may have periods of severe pain and functional limitation. In this situation, the ADA would apply even when the arthritis is in remission. Chronic conditions that are substantially limiting when active or have a high likelihood of recurrence in substantially limiting forms are covered under the ADA.

The ADA requires employers to provide reasonable accommodations to qualified disabled individuals in three areas of employment: 1) the job application process, 2) job functions, and 3) benefits and privileges of employment. A reasonable accommodation is any modification to a job, employment practice or process, or a work environment that makes it possible for an individual with a disability to successfully fulfill the duties of a job. Employers are not required to provide items primarily for personal use, such as purchasing a wheelchair.

Reasonable accommodations are not nearly as costly as many employers fear. A study conducted by the Job Accommodation Network (JAN) in 1990 showed that one third of all accommodations were accomplished with no cost to the employer and more than half cost $1,000.00 or less; eighty percent of the accommodations that JAN suggests cost less than $500.00. Additionally, most employers surveyed indicated that their company had benefited overall financially as a result of making job accommodations.

The individual with a disability will likely have a great deal of experience modifying tasks. It is logical to use his/her expertise. It is also important to consider the individual’s preferences as well as the employer’s needs. Working together to outline various options for accommodating the individual will likely be the most beneficial approach. Occupational therapists can also help by completing evaluations of the workstation and the employee’s functioning. The therapist can offer suggestions for modifying the workstation or the process the employee uses to complete a task. S/he will work with the employer and employee to find accommodations that are both effective and reasonable. Assistance is also available through organizations such as the regional ADA Disability and Business Technical Assistance Center, the Job Accommodation Network, and the local Vocational Rehabilitation office.

Accommodations for employees with arthritis may be administrative or mechanical in nature. Administrative accommodations may include reassigning or reallocating marginal duties, being flexible about how or when tasks are performed, and allowing a flexible work schedule or telecommuting. Reassignment to a different, available job is also an option if no other accommodation is effective.

Mechanical accommodations include modifying the employee’s workstation, modifying or providing special tools or equipment, and ensuring that the building, the work area, and other non-work areas used by employees, such as restrooms and break rooms, are accessible.

For example, an employee with osteoarthritis of the hips or knees may have difficulty standing all day. Providing a stool of the appropriate height would allow the individual to alternate between sitting and standing at a workstation without interrupting production. Another person may have difficulty sitting for long periods. If s/he works at a desk, a podium could be used to raise the work surface allowing the employee to change positions as needed.

More significant accommodations for an individual with arthritis in the lower extremities could include moving a workstation to a ground floor to alleviate the need to climb stairs, or providing another employee to assist with lifting or other physically demanding non-essential tasks.

Arthritis in the hands and arms can be particularly problematic for an individual whose job requires repetitive hand function such as factory assembly or typing. There are a number of adaptive tools available to assist individuals with grasping and manipulating objects. These tools may be especially effective if the individual has arthritis in only one hand. Moving the individual from a job requiring finger manipulations to one requiring gross handling may be an alternative for some individuals. Computer technology provides a number of alternatives for individuals with arthritis in the upper extremities. Adaptive keyboards that reduce stress on the arms are available through most computer dealers. Additionally, a number of voice-activated computer software packages are available to reduce the amount of actual typing the individual must perform. These programs are fairly inexpensive and user-friendly.

Some individuals with arthritis have more difficulty in the morning. Providing a flexible work schedule allowing the employee to start work later in the morning may significantly improve the individual’s ability to perform work functions. Many employers allow employees to work from home. This allows employees to set a schedule that best fits their needs and provides the opportunity to change positions and take breaks when needed.

These are only a few examples of appropriate accommodations for employees with arthritis. Many accommodations can be achieved with little cost to the employer and minimal disruption of the work site. Generally, the cost of the accommodation is far less than the cost of disability payments.