Arthritis

by Dr. Bill Blank, MD
© Copyright 2022. All rights reserved!
Published in Midwest Flyer Magazine June/July 2022 Digital Issue

Arthritis refers to painful, swollen joints with decreased mobility and is the most common cause of disability in the U.S. Approximately 50 million people are affected. It can have a sudden, acute onset or begin gradually. In many cases it becomes chronic. It has aeromedical significance when operation of the controls, or emergency egress of the airplane, is compromised. Medication side effects can become an issue as well.

To oversimplify, there are two types of arthritis: Osteoarthritis, and all the rest. Osteoarthritis is sometimes called wear and tear arthritis. It results from joint use and abuse. Age, heredity, and obesity are risk factors, as is smoking. Damage to the cartilage between the joints occurs. This causes bone to rub against bone and great pain. Joint replacement is frequently needed. All other forms of arthritis comprise a diverse group of diseases which usually result from the body’s immune system attacking and damaging the joints, especially the lining of the joints. Examples are: Ankylosing Spondylitis (arthritis of the spine), Juvenile Arthritis, Gout, Psoriatic Arthritis, and Rheumatoid Arthritis. Gout is not an autoimmune disease, but rather an inflammatory arthritis caused by the deposition of uric acid crystals in the joint.

For pilot certification, the FAA is concerned about joint deformity and decreased range of motion or strength which would impair flight duties. Some of the diseases causing arthritis are systemic diseases. The symptoms of the disease and required medications are important. For mild arthritis, your AME can certify you via a CACI (Conditions AMEs Can Issue). There is a worksheet which you can find online. A status report from your treating physician is required. Osteoarthritis, along with arthritis due to Rheumatoid, Psoriatic, and Ankylosing Spondylitis, can be certified via CACI. The condition must be stable. No more than mild to moderate symptoms are permitted. There must be no significant limitations to range of motion, lifestyle, or activities. Permitted medications include steroids, up to the equivalent of 20 mg of prednisone daily, NSAIDs, methotrexate and others. In some cases, there is a no-fly time after taking the medication. A list of approved medications is on the CACI worksheet. If you know you will need CACI certification, I recommend that you gather up and bring all this information to your flight physical. Your AME must submit your exam within two (2) weeks of his entering your confirmation number into the system. These days, gathering all this information and getting it to your AME within two (2) weeks, can be quite difficult.

If you are not eligible for certification via CACI, you may still be able to receive a Special Issuance Certification. Your AME will need to defer your exam. You can Google the Arthritis Disposition Table in the AME guide. Read carefully and understand the requirements. Be sure you submit EVERYTHING required at the SAME time. Submitting it piecemeal will cause unnecessary delays.

I hope you will not be bothered by arthritis, but if so, there is medical help available and probable certification in most cases. Happy flying!

EDITOR’S NOTE: Columnist William A. Blank is a physician in La Crosse, Wisconsin, and has been an Aviation Medical Examiner (AME) since 1978, and a Senior AME since 1985. Dr. Blank is a retired Ophthalmologist, but still gives some of the ophthalmology lectures at AME renewal seminars. Flying-wise, Dr. Blank holds an Airline Transport Pilot Certificate and has 5600 hours. He is a Certified Instrument Flight Instructor (CFII) and has given over 1200 hours of aerobatic instruction. In addition, Dr. Blank was an airshow performer through the 2014 season and has held a Statement of Aerobatic Competency (SAC) since 1987.

DISCLAIMER: The information contained in this column is the expressed opinion of the author only, and readers are advised to seek the advice of others and refer to the Federal Aviation Regulations and FAA Aeronautical Information Manual for additional information and clarification.

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