Arthritis SI

[My Flight Surgeon]

This is one of several postings outlining the disease process and Special Issuance requirements for this disease.

The word arthritis actually means joint inflammation. The term arthritis is used to describe more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue. The pattern, severity and location of symptoms can vary depending on the specific form of the disease. Typically, rheumatic conditions are characterized by pain and stiffness in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.
Certain factors have been shown to be associated with a greater risk of arthritis. Some of these risk factors are modifiable while others are not.
Non-modifiable risk factors

• Age: The risk of developing most types of arthritis increases with age.
• Gender: Most types ofarthritis are more common in women; 60% of all people with arthritis are women. Gout is more common in men.
• Genetic: Specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA) and systemic lupus erythematous (SLE).

Modifiable risk factors

• Overweight and Obesity: Excess weight can contribute to both the onset and progression of knee osteoarthritis.
• Joint Injuries: Damage to a joint can contribute to the development of osteoarthritis in that joint.
• Infection: Many microbial agents can infect joints and potentially cause the development of various forms of arthritis.
• Occupation: Certain occupations involving repetitive knee bending are associated with osteoarthritis of the knee.

A brief overview of the most common forms of arthritis will be discussed here.

Osteoarthritis is a disease characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth. The breakdown of these tissues eventually leads to pain and joint stiffness. The joints most commonly affected are the knees, hips, and those in the hands and spine. The specific causes of osteoarthritis are unknown, but are believed to be a result of both mechanical and molecular events in the affected joint. Disease onset is gradual and usually begins after the age of 40. There is currently no cure for OA. Treatment for OA focuses on relieving symptoms and improving function, and can include a combination of patient education, physical therapy, weight control, and use of medications.

Rheumatoid arthritis is a systemic inflammatory disease which manifests itself in multiple joints of the body. The inflammatory process primarily affects the lining of the joints (synovial membrane), but can also affect other organs. The inflamed synovium leads to erosions of the cartilage and bone and possibly joint deformity. Pain, swelling, and redness are common joint manifestations. Although the definitive causes are unknown, RA is believed to be the result of a faulty immune response. RA can begin at any age and is associated with fatigue and prolonged stiffness after rest. There is no cure for RA, but new drugs are increasingly available to treat the disease. In addition to medications and surgery, good self-management, including exercise, are known to reduce pain and disability.

Gout is a rheumatic disease resulting from deposition of uric acid crystals (monosodium urate) in tissues and fluids within the body. This process is caused by an overproduction or under excretion of uric acid. Certain common medications and dietary foods are known to be contributory factors. Acute gout will typically manifest itself as an acutely red, hot, and swollen joint with excruciating pain. These acute gouty flare-ups respond well to treatment with oral anti-inflammatory medicines and may be prevented with medication and diet changes. Recurrent bouts of acute gout can lead to a degenerative form of arthritis called gouty arthritis.

Systemic Lupus Erythematosus is an autoimmune disease in which the immune system produces antibodies to cells within the body leading to widespread inflammation and tissue damage. The causes of SLE are unknown but are believed to be linked to genetic, environmental, and hormonal factors. SLE may be characterized by periods of illness and remissions. SLE has a variety of clinical manifestations and can affect joints, skin, brain, lungs, kidneys, and blood vessels. People with SLE may experience fatigue, pain or swelling in joints, skin rashes, and fevers. SLE predominately affects women between the ages of 15 and 40 and blacks more than whites. A team approach in treating lupus if often warranted due to the number of organ systems involved.
The focus of treatment for arthritis is to control pain, minimize joint damage, and improve or maintain function and quality of life. According to the American College of Rheumatology, the treatment of arthritis might involve the following:

• Medication.
• Nonpharmacologic therapies.
  • Physical or occupational therapy.
  • Splints or joint assistive aids.
  • Patient education and support.
  • Weight loss.
• Surgery.

In conjunction with medical treatment, self-management of arthritis symptoms is very important as well.
The Special Issuance process for arthritis. (This does not include mild osteoarthritis controlled by aspirin or NSAID’s that we all have)
If this is a first time issuance of an Authorization for arthritis, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the FAA for the initial determination. The FAA will want to see copies of the pilot’s medical records. These should include the history of the arthritis, a family history, a complete physical examination, copies of any laboratory tests or imaging studies performed, a list of medications with a statement about side effects and the degree of control of the disease.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

• An Authorization granted by the FAA;
• The type of arthritis;
• A general assessment of condition and effect on daily activities;
• The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
• Comments regarding range of motion of neck, upper and lower extremities, hands, etc.

The Examiner must defer to the AMCD or Region if:

• The applicant has developed any associated systemic manifestations;
• If new joints become involved; or
• If the applicant is placed on medication(s) other than those acceptable medications which are aspirin and NSAID’s

[tinman]

Originally Posted by My Flight Surgeon

If this is a first time issuance of an Authorization for arthritis, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the FAA for the initial determination. The FAA will want to see copies of the pilot’s medical records. These should include the history of the arthritis, a family history, a complete physical examination, copies of any laboratory tests or imaging studies performed, a list of medications with a statement about side effects and the degree of control of the disease.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

• An Authorization granted by the FAA;
• The type of arthritis;
• A general assessment of condition and effect on daily activities;
• The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
• Comments regarding range of motion of neck, upper and lower extremities, hands, etc.

The Examiner must defer to the AMCD or Region if:

• The applicant has developed any associated systemic manifestations;
• If new joints become involved; or
• If the applicant is placed on medication(s) other than those acceptable medications which are aspirin and NSAID’s

...and then the FAA will take 7 months to get your SI back to you! Of course I could just have been special . Gotta give props to Docs such as yourself. I don't know many people who could deal with the FAA as often as you and still want to live !

[My Flight Surgeon]

Actually the problem with obtaining a Special Issuance is that most people don't submit everything the FAA wants in the initial package. That leads to a sea of correspondence and delays because every time the data goes back to the FAA it goes to the end of the queue.

[tinman]

I can see that being a problem, but it wasn't in my case.

Here's how it went down-sent my stuff, called'em and we were told that everything was received. 2-3 months go by with no word. Called them back and they told us they had nothing on me and to re-send everything.They had lost everything in 2 months! So another 3 months go by until I get the good letter in the mail. All the while I'm out of a job because of no medical. AAARRR!

I still dread dealing with the FAA, but my Doctor has been extremely helpful. Worth every penny.

[My Flight Surgeon]

We ALWAYS sen everything FEDEX or UPS. A signature helps track it down. We also call if we have not heard anything at 4 weeks.

[tinman]

That's the weird thing. We sent FedEx, called and they told us everything was there. 2 or 3 weeks later, POOF, MIA. Only to me!

[My Flight Surgeon]

I don't have anything to say other than NO SH#&.

When I send my stuff, I make the labels on-line and track the shipment on-line. This gives you the name of the person who accepted the package. At least you can tack someone with the blame