Question on rheumatoid arthritis diagnosis

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I have a private pilot certificate and passed my last third class medical about mid-year last year. A few months later I started having symptoms that, after first waiting to see if they were just temporary, finally (via my primary care physician) lead me to a rheumatologist, who has just diagnosed me with "mild" rheumatoid arthritis. Some osteo arthritis was noted in some joints - also mild and rather secondary.

The doctor prescribed Plaquenil and Naprosyn (the latter in place of the Ibuprofen I had self-prescribed till all my docs got in a row. I have made an eye doctor appointment for the Plaquenil Eye Exam evaluation.)

I had been planning to try for an instrument rating, but I wasn't even sure whether I could even fly now. So to figure that out I reviewed section 61.53 of the regs. It tells me I can't fly if I know or have reason to know that my condition would make me unable to meet the medical requirements. While I honestly believe my current condition does not preclude me from safe flying, I also searched the FAA web site to see whether the FAA considered RA disqualifying. I think it says I would need a Special Issuance. Which all leads me to my one question:

If I wanted to go for my instrument rating and make sure my private pilot hours are legal with respect to 61.53, am I grounded till I (hopefully) get a SI, or can I fly till my current medical expires - or at least until I decide I have become too crippled to fly safely?

I guess I'm just not clear whether a condition requiring an SI is immediately grounding for exercise of PP privileges - I think an SI condition isn't grounding for sport pilot, though I'm not sure of that. Thought I saw a link recently that said that...

I would hate to get my instrument rating using my current medical but then when I take my next medical exam have someone notice that I reported being diagnosed with RA just prior to getting that rating. One (paranoid?) possibility occurs to me is that the FAA could say I was flying under PP privilege when I knew I medically couldn't, and penalize me by denying my medical, making it impossible to even fly under sport pilot regs.
 
Look up 67.313.

Rheumatoid arthritis on Plaquenil is pretty easy to SI. Need an opthalmologist' dilated exam report annualy on form 8500-7 testifying to zero plaquenil deposits (and you want to know that anyway) , and a letter from you doc testifying to the fact you are stable and not limited in day to day activities.

If your major concern is to be caught post hoc, then don't set that up. Self ground get on placquenil, wait until you have improvement, go to the eye guy, then back to your rx-ing doc, get the docuemntation, we get the SI, and you do your I.R.
 
bbchien said:
Look up 67.313.

Rheumatoid arthritis on Plaquenil is pretty easy to SI. Need an opthalmologist' dilated exam report annualy on form 8500-7 testifying to zero plaquenil deposits (and you want to know that anyway) , and a letter from you doc testifying to the fact you are stable and not limited in day to day activities.

If your major concern is to be caught post hoc, then don't set that up. Self ground get on placquenil, wait until you have improvement, go to the eye guy, then back to your rx-ing doc, get the docuemntation, we get the SI, and you do your I.R.
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Bruce - I'm the OP. Thank you for the very prompt reply. I will follow your advice. Due to weather and work schedule I haven't flown since December anyway, so a bit more self-grounding isn't going to bother me.

My rheumatologist does not appear to be familiar with dealing with patients who are also pilots. I may seek your services though I will first see if I can consult with my local AME about working through the paperwork.

woodstock said:
Are you sure you don't have Lyme or some other tick borne illness?
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I'm not sure. No tests were done for that. But I live in western Oregon and from what I've read, Lyme disease is fairly rare here. My RF and anti-CCP numbers are both high, which I believe indicates a high probability of my symptoms being due to RA. On the other hand my most recent ESR was 8 (0 to 25 normal) and CRP was 0.1 (0.0 to 0.4 normal) are both within normal ranges.

Since you asked, I'll bore you with a few more details:

On the other hand, my rheumatologist has not been able to explain the very first symptoms I had: fairly sudden onset of my leg calves feeling like they were about to cramp - though they rarely did. This was happening at night. Plus my knee caps started getting sore. I was also starting to get a mix of other minor muscle and joint soreness elsewhere - with the bottom of my feet getting sore (started out feeling like I was walking on bunched-up socks.) But other than some barely visible redness near a couple finger knuckles, no visible swelling or redness on any other joints. And no rashes that I have observed.

The cramping problem seems to have subsided - but I had started supplementing with KCl and magnesium, so that might be why.
 
I'd go to a Lyme specialist and get thoroughly checked. Make sure they are a specialist, and there are some aggressive tests that will ferret out whether or not there are critters burrowing.

Finding out if you do, and treating it successfully, is wayyy more important than any medical issues you may or may not encounter. You don't mess with the tick borne BS.
 
woodstock said:
I'd go to a Lyme specialist and get thoroughly checked. Make sure they are a specialist, and there are some aggressive tests that will ferret out whether or not there are critters burrowing.

Finding out if you do, and treating it successfully, is wayyy more important than any medical issues you may or may not encounter. You don't mess with the tick borne BS.
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Lyme should be easily detected, since you can use PCR to detect the spirochetes that cause it.
 
There is an old adage in medicine. When you hear hoofbeats, look for horses, not zebras.

If you have a concern for lyme, which sounds unlikely, discuss it with your Rheumatologist before you go off on some medical misadventure. They can do screening testing very easily or discuss the clinical features that would make it unlikely.
 
Doggtyred said:
There is an old adage in medicine. When you hear hoofbeats, look for horses, not zebras.

If you have a concern for lyme, which sounds unlikely, discuss it with your Rheumatologist before you go off on some medical misadventure. They can do screening testing very easily or discuss the clinical features that would make it unlikely.
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Absolutely. But like Babesiosis, you have to THINK OF IT to test for it.
Think "Louis Rich Turkey Plant epidemic" mid 1970s. Babesia can be checked, serologically, too....
 
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