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Inflammation or degenerative disease of joints causes pain and swelling which may interfere with the safe operation of an aircraft. Applicants with arthritis presenting for initial medical certification may be assessed fit if their condition is in remission or their symptoms are under control with acceptable medication but should be warned that they may have to be assessed unfit if their medical situation changes. Applicants presenting for recertification should be pain free and have a satisfactory range of movements and strength.
Ankylosing spondylitis is a chronic autoimmune inflammatory arthritis mainly affecting the spine and sacroiliac joints, with pain, restricted movement and permanent skeletal deformity. It is commonly associated with iritis and uveitis causing pain, impaired vision and photophobia, and with fatigue. It is progressive and all aviation licence holders suffering from the condition will require frequent assessment of musculoskeletal function to ensure they can sit comfortably in an acceptable posture with a range of pain-free movement sufficient to keep a satisfactory lookout, monitor the instruments and operate the controls safely. Moderate to severe cases have an increased risk of fracture (e.g. following an accident or heavy landing) and this should be considered by AMEs during their assessment. All cases where there is evidence on examination of limitation of movement should undergo a medical flight test with a CAA Flight Instructor Examiner (Class 2) or Training Captain (Class 1). Episodes of inflammatory eye disease will entail an unfit assessment.
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