Earlier in August, we started discussing Conditions AMEs Can Issue (CACI). Today we will look at a specific one: Arthritis.
At its core Arthritis is inflammation of joints. There are many types of arthritis. The one most people initially think of is osteoarthritis, which is generally considered degeneration of a joint from age and/or excessive use. Osteoarthritis is highly prevalent and can be debilitating[1], depending on what joints are involved and just how bad the disease is. While Osteoarthritis can affect many different types of joints, it is most prevalent in the knees with an estimated 14 million people in America[1].
Most people with Osteoarthritis can be issued their medical certificate without even needing the CACI as long as they are managed with traditional anti-inflammatory medication and have no functional limitations [2].
Outside of Osteoarthritis, the remaining causes of chronic arthritic conditions are mostly associated with auto-immune disease. Auto-immune diseases are situations where our own immune system mistakes some part of our body as a foreign substance and tries to eliminate it. There are many different auto-immune diseases, but the ones that primarily cause arthritis are Rheumatoid, Psoriatic, or Ankylosing Spondylitis. Unfortunately, these diseases can require significantly more potent medications and this is the reason for the CACI.
If you find yourself in a position of having auto-immune inflammatory arthritis, the CACI allows for the AME to issue you the medical certificate so long as everything is going well. You can find the CACI here, but let’s go through the requirements[3]:
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The treating physician must find you stable and have no changes planned
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You must not have symptoms significant enough to disrupt your life
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It can only be Osteoarthritis, Rheumatoid, Psoriatic, or Ankylosing Spondylitis
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If you are taking auto-immune medication, then your associated lab values must be normal (auto-immune medication can have side effects)
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Acceptable medications include:
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Oral steroid which does not exceed the equivalent of prednisone 20 mg/day
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NSAIDS
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Methotrexate
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Hydroxychloroquine/ Chloroquine
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Specific status report required
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Only ONE of the following – with required no-fly time after each use:
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adalimumab (Humira): 4-hour no-fly
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apremilast (Otezla): n/a
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etanercept (Enbrel): 4-hour no-fly
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infliximab (Remicade): 24-hour no-fly
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rituximab (Rituxan): 72-hour no-fly
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secukinumab (Cosentyx): 4-hour no-fly
If you meet all of the CACI requirements then you should get issued your certificate at your exam. Just keep in mind that you will need to be prepared. In order to prove to your AME that you do meet the requirements of the CACI you will need to be prepared to bring the evidence by way of notes from your treating physician, your medication list, and possibly lab work.
