Skip to content
Fatigue Survey
Exploring the prevalence of fatigue among autoimmune patients
*
1.
Have you been diagnosed with an autoimmune disease?
(Required.)
Yes
No
Don't know/ No answer
*
2.
How many autoimmune diseases do you have?
(Required.)
1
2
3
4
5or >
*
3.
Please name the primary disease.
(Required.)
Acute disseminated encephalomyelitis
Acute hemorragic leukoencephalitis
Acute motor axonal neuropathy
Addison's disease
Adult-onset Still's disease
Agammaglobulinemia
Alopecia areata
Amyloidosis, autoimmune
ANCA associated vasculitis
Angioedema, autoimmune
Ankylosing spondylitis
Anti-glomerular basement membrane nephritis
Anti-NMDA receptor encephalitis
Antiphospholipid syndrome
Antisynthetase syndrome
Aplastic anemia, autoimmune
Atherosclerosis, autoimmune
Baló disease/Baló concentric sclerosis
Behçet's disease
Bickerstaff's encephalitis
Bullous pemphigoid
Cardiomyopathy
Castleman's disease
Celiac disease
Chronic fatigue syndrome
Chronic inflammatory demyelinating polyneuropathy (CIDP)
Chronic Lyme disease
Chronic recurrent multifocal osteomyelitis
Churg-Strauss syndrome
Cicatricial pemphigoid
Clinically isolated syndrome (CIS, MS)
Cogan's syndrome
Cold agglutinin disease
Complement component 2 deficiency
Complex regional pain syndrome
Congenital heart block
Coxsackie myocarditis
CREST syndrome
Crohn's disease
Demyelinating diseases
Dermatitis herpetiformis
Dermatomyositis
Discoid lupus
Drug-induced lupus
Dysautonomia
Endometriosis
Enteropathy, autoimmune
Eosinophilic esophagitis
Eosinophilic fasciitis
Epidermolysis bullosa acquisita
Erythema nodosum
Essential mixed cryoglobulinemia
Evans syndrome
Felty syndrome
Fibromyalgia
Gestational pemphigoid
Giant cell arteritis
Giant cell myocarditis
Glomerulonephritis
Granulomatosis with polyangiitis (formerly Wegener's)
Graves' disease
Graves' ophthalmopathy
Guillain-Barré syndrome
Hashimoto's encephalopathy
Hashimoto's thyroiditis
Hemolytic anemia, autoimmune
Henoch-Schonlein purpura
Hepatitis, autoimmune
Hereditary sensory and autonomic neuropathies
Hidradentitis suppurativa
Hughes-Stoivin syndrome
Hypogammaglobulinemia
IgG4-related systemic disease
Inclusion body myositis
Inner ear disease, autoimmune
Intermediate uveitis
Interstitial cystitis
IPEX syndrome
Juvenile Arthritis
Juvenile myositis
Kawasaki disease
Lambert-Eaton myasthenic syndrome
Leukocytoclastic vasculitis
Lichen planus
Lichen sclerosus
Ligneous Conjunctivitis
Linear IgA disease
Lupus erythematosus
Lupus nephritis
Lupus vasculitis
Lymphoproliferative syndrome, (ALPS)
Ménière's disease
Microscopic colitis
Microscopic polyangiitis
Miller-Fisher syndrome
Mixed connective tissue disease (MCTD)
Mooren's ulcer
Morphea
Mucha-Habermann disease
Multiple sclerosis
Myasthenia gravis
Myocarditis
Myositis, autoimmune
Neonatal myasthenia gravis
Neuromyelitis optica (NMO)
Neuromyotonia
Neutropenia, autoimmune
Ocular Cicatricial Pemphigoid
Oophoritis
Opsoclonus myoclonus syndrome
Optic neuritis
Orchitis
Ord's thyroiditis
Palindromic rheumatism
Pancreatitis, autoimmune
PANDAS/PANS Pediatric Neuropsychiatric disorders associated with Streptococcus
Paraneoplastic cerebeller degeneration
Paraneoplastic syndromes
Paroxysmal nocturnal hemoglobinuria (PNH)
Parry Romberg syndrome
Pars planitis
Parsonnage-Turner syndrome
Pemphigus vulgaris
Peripheral neuropathy, autoimmune
Pernicious anemia
POEMS syndrome
Polyarteritis nodosa
Polyglandular syndrome type 1, autoimmune
Polyglandular syndrome type 2, autoimmune
Polyglandular syndrome type 3, autoimmune
Polymyalgia rheumatica
Polymyositis
Postmyocardial infarction syndrome
Primary biliary cholangitis
Primary progress multiple sclerosis
Primary sclerosing cholangitis
Progesterone dermatitis, autoimmune
Progressive inflammatory neuropathy
Psoriasis
Psoriatic arthritis
Pulmonary Fibrosis
Pure red cell aplasia
Pyoderma gangrenosum
Raynaud's phenomenon
Reactive arthritis (formerly known as Reiter's syndrome)
Relapsing polychondritis
Relapsing-remitting multiple sclerosis
Restless legs syndrome
Retinopathy, autoimmune
Retroperitoneal fibrosis
Rheumatic fever
Rheumatoid arthritis
Rheumatoid vasculitis
Sarcoidosis
Scleritis of the eye
Scleroderma
Secondary progressive multiple sclerosis
Sjogren's syndrome
Stiff person syndrome
Subacute bacterial endocarditis
Susac's syndrome
Sydenham chorea
Sympathetic ophthalmia
Systemic lupus erythematosus
Systemic scleroderma (see scleroderma)
Takayasu's arteritis
Thrombocytopenia
Thrombocytopenic purpura, autoimmune
Thyroiditis, autoimmune
Tolosa-Hunt syndrome
Transverse myelitis
Type 1 Diabetes
Ulcerative colitis
Undifferentiated mixed connective disease (UCTD)
Urticaria, autoimmune
Urticarial vasculitis
Uveitis, autoimmune
Vasculitis
Vitiligo
Vogt-Koyanagi-Harada syndrome (uveomeningoencephalitis syndrome)
Warm Autoimmune Hemolytic Anemia (wAIHA)
4.
Please name the secondary disease.
Acute disseminated encephalomyelitis
Acute hemorragic leukoencephalitis
Acute motor axonal neuropathy
Addison's disease
Adult-onset Still's disease
Agammaglobulinemia
Alopecia areata
Amyloidosis, autoimmune
ANCA associated vasculitis
Angioedema, autoimmune
Ankylosing spondylitis
Anti-glomerular basement membrane nephritis
Anti-NMDA receptor encephalitis
Antiphospholipid syndrome
Antisynthetase syndrome
Aplastic anemia, autoimmune
Atherosclerosis, autoimmune
Baló disease/Baló concentric sclerosis
Behçet's disease
Bickerstaff's encephalitis
Bullous pemphigoid
Cardiomyopathy
Castleman's disease
Celiac disease
Chronic fatigue syndrome
Chronic inflammatory demyelinating polyneuropathy (CIDP)
Chronic Lyme disease
Chronic recurrent multifocal osteomyelitis
Churg-Strauss syndrome
Cicatricial pemphigoid
Clinically isolated syndrome (CIS, MS)
Cogan's syndrome
Cold agglutinin disease
Complement component 2 deficiency
Complex regional pain syndrome
Congenital heart block
Coxsackie myocarditis
CREST syndrome
Crohn's disease
Demyelinating diseases
Dermatitis herpetiformis
Dermatomyositis
Discoid lupus
Drug-induced lupus
Dysautonomia
Endometriosis
Enteropathy, autoimmune
Eosinophilic esophagitis
Eosinophilic fasciitis
Epidermolysis bullosa acquisita
Erythema nodosum
Essential mixed cryoglobulinemia
Evans syndrome
Felty syndrome
Fibromyalgia
Gestational pemphigoid
Giant cell arteritis
Giant cell myocarditis
Glomerulonephritis
Granulomatosis with polyangiitis (formerly Wegener's)
Graves' disease
Graves' ophthalmopathy
Guillain-Barré syndrome
Hashimoto's encephalopathy
Hashimoto's thyroiditis
Hemolytic anemia, autoimmune
Henoch-Schonlein purpura
Hepatitis, autoimmune
Hereditary sensory and autonomic neuropathies
Hidradentitis suppurativa
Hughes-Stoivin syndrome
Hypogammaglobulinemia
IgG4-related systemic disease
Inclusion body myositis
Inner ear disease, autoimmune
Intermediate uveitis
Interstitial cystitis
IPEX syndrome
Juvenile Arthritis
Juvenile myositis
Kawasaki disease
Lambert-Eaton myasthenic syndrome
Leukocytoclastic vasculitis
Lichen planus
Lichen sclerosus
Ligneous Conjunctivitis
Linear IgA disease
Lupus erythematosus
Lupus nephritis
Lupus vasculitis
Lymphoproliferative syndrome, (ALPS)
Ménière's disease
Microscopic colitis
Microscopic polyangiitis
Miller-Fisher syndrome
Mixed connective tissue disease (MCTD)
Mooren's ulcer
Morphea
Mucha-Habermann disease
Multiple sclerosis
Myasthenia gravis
Myocarditis
Myositis, autoimmune
Neonatal myasthenia gravis
Neuromyelitis optica (NMO)
Neuromyotonia
Neutropenia, autoimmune
Ocular Cicatricial Pemphigoid
Oophoritis
Opsoclonus myoclonus syndrome
Optic neuritis
Orchitis
Ord's thyroiditis
Palindromic rheumatism
Pancreatitis, autoimmune
PANDAS/PANS Pediatric Neuropsychiatric disorders associated with Streptococcus
Paraneoplastic cerebeller degeneration
Paraneoplastic syndromes
Paroxysmal nocturnal hemoglobinuria (PNH)
Parry Romberg syndrome
Pars planitis
Parsonnage-Turner syndrome
Pemphigus vulgaris
Peripheral neuropathy, autoimmune
Pernicious anemia
POEMS syndrome
Polyarteritis nodosa
Polyglandular syndrome type 1, autoimmune
Polyglandular syndrome type 2, autoimmune
Polyglandular syndrome type 3, autoimmune
Polymyalgia rheumatica
Polymyositis
Postmyocardial infarction syndrome
Primary biliary cholangitis
Primary progress multiple sclerosis
Primary sclerosing cholangitis
Progesterone dermatitis, autoimmune
Progressive inflammatory neuropathy
Psoriasis
Psoriatic arthritis
Pulmonary Fibrosis
Pure red cell aplasia
Pyoderma gangrenosum
Raynaud's phenomenon
Reactive arthritis (formerly known as Reiter's syndrome)
Relapsing polychondritis
Relapsing-remitting multiple sclerosis
Restless legs syndrome
Retinopathy, autoimmune
Retroperitoneal fibrosis
Rheumatic fever
Rheumatoid arthritis
Rheumatoid vasculitis
Sarcoidosis
Scleritis of the eye
Scleroderma
Secondary progressive multiple sclerosis
Sjogren's syndrome
Stiff person syndrome
Subacute bacterial endocarditis
Susac's syndrome
Sydenham chorea
Sympathetic ophthalmia
Systemic lupus erythematosus
Systemic scleroderma (see scleroderma)
Takayasu's arteritis
Thrombocytopenia
Thrombocytopenic purpura, autoimmune
Thyroiditis, autoimmune
Tolosa-Hunt syndrome
Transverse myelitis
Type 1 Diabetes (Diabetes mellitus)
Ulcerative colitis
Undifferentiated mixed connective disease (UCTD)
Urticaria, autoimmune
Urticarial vasculitis
Uveitis, autoimmune
Vasculitis
Vitiligo
Vogt-Koyanagi-Harada syndrome (uveomeningoencephalitis syndrome)
Warm Autoimmune Hemolytic Anemia (wAIHA)
*
5.
Would you say fatigue is a major issue for you?
(Required.)
Yes
No
Don't know/ No answer
*
6.
Which statement better describes your fatigue:
(Required.)
My fatigue is a like a normal tiredness.
My fatigue is anything but normal. It is profound and prevents me from doing the simplest of everyday tasks.
Neither/ No answer
7.
Would you say that fatigue is “probably the most debilitating symptom of having an autoimmune disease?”
Yes
No
Don't know/ No answer
*
8.
Does your fatigue impact your:
(Required.)
A great deal
A lot
A moderate amount
A little
None at all
Overall Quality of Life
A great deal
A lot
A moderate amount
A little
None at all
Sense of Self-Esteem
A great deal
A lot
A moderate amount
A little
None at all
Family Relationships
A great deal
A lot
A moderate amount
A little
None at all
Parenting Abilities
A great deal
A lot
A moderate amount
A little
None at all
Romantic Relationships
A great deal
A lot
A moderate amount
A little
None at all
Professional Relationships
A great deal
A lot
A moderate amount
A little
None at all
Career/ Ability to Work
A great deal
A lot
A moderate amount
A little
None at all
Mental Health/ Emotional State/ Mental Well-being
A great deal
A lot
A moderate amount
A little
None at all
*
9.
Have you ever discussed your fatigue with your doctor?
(Required.)
Yes
No
Don't know/ No answer
10.
Did your doctor understand the extent of your fatigue?
Yes
No
Don't know/ No answer
11.
Did your doctor prescribe or suggest treatment options for your fatigue?
Yes
No
Don't know/ No answer
12.
Have you ever discussed your fatigue with your family and friends?
Yes
No
Don't know/ No answer
13.
Did your family and friends understand the extent of your fatigue?
Yes
No
Don't know/ No answer
14.
Do you believe others judge you negatively because of your fatigue?
Yes
No
Don't know/ No answer
15.
What would you like people to know about your fatigue?
16.
What’s your current work status?
Fulltime job
Part-time job
No job
Unable to work/ No disability
Unable to work/ Collecting disability
17.
Has your fatigue resulted in:
A great deal
A lot
A moderate amount
A little
Not at all
Depression
A great deal
A lot
A moderate amount
A little
Not at all
Anxiety
A great deal
A lot
A moderate amount
A little
Not at all
Increased Emotional Stress
A great deal
A lot
A moderate amount
A little
Not at all
Sense of Isolation
A great deal
A lot
A moderate amount
A little
Not at all
Ability to work
A great deal
A lot
A moderate amount
A little
Not at all
Loss of employment
A great deal
A lot
A moderate amount
A little
Not at all
Filing for disability
A great deal
A lot
A moderate amount
A little
Not at all
Financial distress
A great deal
A lot
A moderate amount
A little
Not at all
18.
Have you sought professional mental health treatment as a result of your fatigue?
Yes
No
Don't know/ No answer
19.
Has your primary care doctor suggested you contact a mental health professional as a result of your fatigue?
Yes
No
Don't know/ No answer
*
20.
How much do you think race played in the acknowledgement or lack thereof of your fatigue symptoms?
(Required.)
A great deal
A lot
A moderate amount
A little
None at all
21.
What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
22.
What is your gender?
Male
Female
Transgender
No answer/ Prefer not to say
Other (please specify)
*
23.
What is your ethnicity? (Please select all that apply.)
(Required.)
American Indian or Alaskan Native
Asian or Pacific Islander
Black or African American
Hispanic or Latino
White / Caucasian
Prefer not to answer
Other (please specify)
24.
Would you be willing to be contacted for further information? If yes, please answer the following:
First name
Email address
