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Do you consent to the collection and processing of your personal data (including information about your health, race and ethnicity (as applicable); including disclosure to our Research Partners and service providers) for the purpose of recruitment into clinical research studies? *
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First Name *
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Date of Birth MM/DD/YYYY *
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Are you Male or Female? *
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Have you been diagnosed with rheumatoid arthritis
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Yes – I have Rheumatoid Arthritis
No
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How long ago were you first diagnosed with rheumatoid arthritis? *
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Less than 3 months ago
4-5 months ago
6+ months ago
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How many swollen joints do you currently have? *
A swollen joint refers to a joint (e.g., finger, hip, knee, elbow, ankle) where there is an increased amount of fluid in the tissues around a joint
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0-3
4-8
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How many
tender (painful/sensitive/aching/sore)
joints do you currently have? *
A tender joint is when a joint (e.g., finger, hip, knee, elbow, ankle) feels uncomfortable or you experience pain, especially while moving.
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0-3
4-8
8+
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Would you consider a surgical procedure/implanted device as a treatment for your rheumatoid arthritis? *
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Yes - I would consider this for a treatment
No
Not Sure - I would need more information
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Which of the following medications have you tried (now or in the past) for your rheumatoid arthritis? *
Please select all that apply...
Trademarks are property of their rightful owners.
ACTEMRA® (tocilizumab)
CIMZIA® (certolizumab pegol)
ENBREL® (etanercept)
HUMIRA® (adalimumab)
KEVZARA® (sarilumab)
KINERET® (anakinra)
OLUMIANT® (baricitinib)
ORENCIA® (abatacept)
REMICADE® (infliximab)
RINVOQ® (upadacitinib)
RITUXAN® (rituximab)
SIMPONI® (golimumab)
XELJANZ® (tofacitinib)
No - I have not tried any of the medications listed
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Have any of the above treatments helped with the symptoms of your rheumatoid arthritis? *
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Yes – greatly helped
Yes – helped in the past but no longer helps
Yes – helped in the past but no longer helps
No – not helped at all
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Are you currently taking one of the following medications for your rheumatoid arthritis? *
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Trademarks are property of their rightful owners.
TREXALL® (methotrexate)
ARAVA® (leflunomide)
Sulfasalazine
Gold salts (chrysotherapy or aurotherapy)
CUPRIMINE® (penicillamine)
PLAQUENIL® (hydroxychloroquine)
IMURAN® (azathioprine)
Unsure
None of the above
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Have you been diagnosed (
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(For example: Human immunodeficiency virus, HIV, Hepatitis C, Hepatitis B, tuberculosis, TB, cirrhosis, pancreatitis, cancer, or had a splenectomy).
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Please only include conditions which have been diagnosed by a doctor.
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Are you taking any other medications for your rheumatoid arthritis or other health conditions? *
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How much do you weigh in lbs (pounds)? *
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If female, are you currently pregnant, breastfeeding or planning to become pregnant? *
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N/A
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Which racial or ethnic group(s) do you identify with? *
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