Rheumatology History
Country of Residence
If you chose Other, please specify:
Your answer
Have you or someone in your family (blood relative) been diagnosed with a Rheumatic Disease?
Yourself
Relative
Rheumatoid Arthritis
Systemic Lupus Erythematous
Antiphospholipid Syndrome
Ankylosing Spondylitits
Scleromderma
Sjogren's Syndrome
Vasculitis
Polymyositis
Fibromyalgia
Psoriatic Arthritis
If other, please specify here
Your answer
Date of Birth (year):
Your answer
Year of symptom onset:
Your answer
Year diagnosed:
Your answer
Year initiated first treatment:
Your answer
When were you diagnosed with the Rheumatic Disease:
Did you ever experience any of the conditions below? If yes, please tick:
What medications are you currently taking:
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