A Proposed Aeromedical Disposition Flowchart for Systemic Lupus Erythematosus

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement. Clinical management of this condition has unique aeromedical considerations and an impact on subsequent aeromedical disposition. A comprehensive decision matrix would greatly benefit aviation medicine practitioners in the management of aircrew and personnel in flying-related vocations who are diagnosed with SLE.CASE REPORT: We describe the aeromedical management of a military air traffic controller who was diagnosed with SLE after presenting with cutaneous lupus, nonscarring alopecia, symmetrical small joint polyarthropathy, leukopenia, and presence of SLE-specific antibody. She was treated with hydroxychloroquine and low-dose systemic glucocorticoids, and allowed to return to duties with a proximity restriction and a bar on field deployments and night duties.DISCUSSION: Several SLE manifestations may have either incapacitating or distracting effects on aircrew and personnel in flying-related vocations. Some medications used in the treatment of SLE may similarly impact on an individuals ability to safely execute flight or air traffic control duties. We propose an aeromedical disposition decision flowchart that would guide aviation medicine practitioners in the management of individuals diagnosed with SLE to ensure optimal and safe performance in their respective occupational settings.Seah BZQ, Chua CG.