As we get a little older its par for the course to get a little stiff and have a few aches and pains. If you fall into that silver-hair category, try sitting in a GA cockpit for five hours and then spring onto the tarmac. Make sure there’s somebody there to catch you! Sometimes however, those aching joints can get out of hand. Swelling, redness, pain, warmth and loss of function in a joint mean you’ve got arthritis.
Arthritis happens frequently and comes in many forms. The most common type is osteoarthritis (OA). It’s due to wear and tear of a joint. As you might expect it tends to occur as you get older and most often affects the weight bearing joints like the knee and hip. Symptomatic knee OA occurs in 10% men and 13% in women aged 60 years or older. Being overweight increases your chances of getting arthritis as does smoking and working in occupations with a high physical workload. Joint pain from OA is what prompts most folks to go to the doctor and is what makes it a crippling condition. So as you might expect, OA has a big impact on our aging pilot population. The mainstay of treatment is aspirin, ibuprophen or one of the more powerful non-steroidal anti-inflammatory drugs (NSAIDs). When things get really bad though, total hip and/or total knee replacement is often necessary.
Gout is the second most common cause of arthritis. It also attacks weight bearing joints although, most commonly, the toe rather than the knee or hip. Fortunately most cases of gouty arthritis can be treated and joint damage prevented by using drugs that lower uric acid in the blood. Uric acid crystals deposit in the toe and give you a sore swollen joint. Lower the uric acid and voila! You’re better.
The third most common form of arthritis is rheumatoid arthritis (RA). It’s seen less frequently than OA but can be much more severe and more rapidly progressive. It is a so-called auto-immune disorder where your own immune system attacks the joint tissue. Folks with RA do much better if aggressive treatment is started early on rather than waiting until the immune system has wrecked a joint. Unfortunately this sometimes means using so-called immuno-suppressants—powerful drugs that can have powerful side-effects. A similar auto-immune arthritis can sometimes be seen with a skin condition called psoriasis.
So how does the FAA and your AME decide if you’re OK to fly with arthritis? It mostly depends on how badly you are impaired and how much side-effect you get from your medications. If you have simple OA and are taking NSAIDs on an as-needed basis you’re AME can issue a medical certificate on the spot if you don’t have any functional limitations and no persistent daily symptoms. However, if you have RA, arthritis from psoriasis or have OA requiring medicines other than NSAIDs your AME will need a report from your doc about your condition, treatment and response to drugs. If your arthritis is stable, you don’t require more than low dose steroids, NSAIDs, or a drug called methotrexate, and required blood work is normal, your AME can issue a medical certificate. If you are taking a drug called hydroxychloroquine (Plaquenil) you will also need an eye examination as this medicine sometimes can affect vision. This medical certificate will be a so-called CACI (Conditions an AME Can Issue) Issuance. This means that if you have a First or Second Class certificate you will need to repeat the blood work, eye exam and treating physician evaluation yearly. For a Third Class these things have to be repeated with each required medical exam. You will again have to bring this information to your AME and if everything again looks OK he can re-issue.
If you can’t meet these criteria, you’re AME will have to defer your case to the FAA’s Aerospace Medical Certification Division for further evaluation. You will probably have to submit a lot of medical records, but do stick with it and give them what they want. Unless you are really in bad shape you should be able to get your medical certificate from the FAA under a so-called Special Issuance (SI). With most SI’s your AME can usually do subsequent yearly reviews and issue a medical certificate if your condition has been stable.
Bottom line: if you don’t need a walker to get to your airplane you’ll probably be able to keep on burning avgas!
Fly wisely. See you next month.
As always, comments, questions and suggestions are welcome: