Rheumatoid Arthritis (MR) Survey

We are a branch of a larger market research company, whose goal is to make contact with as many people diagnosed or involved in the treatment of Rheumatoid Arthritis. We will be looking to reach out to those interested in the form of online surveys and telephone discussions to help understand the needs of Rheumatoid Arthritis patients and caregivers. When contacted and qualified we will pay respondents for their time (up to $100).

All information collected during the surveys or phone discussions will be completely confidential in that we will not show your name or any other identifying information to our clients.

Question Title

* 1. When Diagnosed?

Question Title

* 2. Please provide information regarding treatment previously taken and current treatment:

	Previous	Currently
NSAIDs (Advil, Motrin, others) and naproxen (Aleve)	NSAIDs (Advil, Motrin, others) and naproxen (Aleve) Previous	NSAIDs (Advil, Motrin, others) and naproxen (Aleve) Currently
Steroids Corticosteroid medications, such as prednisone	Steroids Corticosteroid medications, such as prednisone Previous	Steroids Corticosteroid medications, such as prednisone Currently
methotrexate	methotrexate Previous	methotrexate Currently
hydroxychloroquine (Plaquenil)	hydroxychloroquine (Plaquenil) Previous	hydroxychloroquine (Plaquenil) Currently
sulfasalazine (Azulfidine)	sulfasalazine (Azulfidine) Previous	sulfasalazine (Azulfidine) Currently
minocycline (Dynacin, Minocin, others)	minocycline (Dynacin, Minocin, others) Previous	minocycline (Dynacin, Minocin, others) Currently
lummunosuppressants (Imuran Gengraf, etc)	lummunosuppressants (Imuran Gengraf, etc) Previous	lummunosuppressants (Imuran Gengraf, etc) Currently
etanercept (Enbrel)	etanercept (Enbrel) Previous	etanercept (Enbrel) Currently
infliximab (Remicade)	infliximab (Remicade) Previous	infliximab (Remicade) Currently
adalimumab (Humira)	adalimumab (Humira) Previous	adalimumab (Humira) Currently
golimumab (Simponi)	golimumab (Simponi) Previous	golimumab (Simponi) Currently
certolizumab (Cimzia)	certolizumab (Cimzia) Previous	certolizumab (Cimzia) Currently
anakinra (Kineret)	anakinra (Kineret) Previous	anakinra (Kineret) Currently
abatacept (Orencia)	abatacept (Orencia) Previous	abatacept (Orencia) Currently
rituximab (Rituxan)	rituximab (Rituxan) Previous	rituximab (Rituxan) Currently
tocilizumab (Actemra)	tocilizumab (Actemra) Previous	tocilizumab (Actemra) Currently

Other (please specify)

Question Title

* 3. Please provide contact information as noted, name and phone # are requested not required at this time:

Name:

ZIP: *

Country: *

Email Address: *

Phone Number:

Thank you very much for taking the time to fill out this short questionnaire. We are collecting basic information to match individuals with specific survey requirements in order to invite your participation.