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Protocol - Personal and Family History of Psoriasis

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Description:

The Self Evaluation plus Medication Survey is a self-administered instrument which was developed from the questionnaires used in the Collaborative Association Study of Psoriasis (CASP), which is a Genetic Association Information Network (GAIN) genome-wide association study (GWAS). The Self Evaluation plus Medication Survey collects information on individuals with psoriasis and controls, and their family history of psoriasis and other autoimmune diseases. Additionally, for individuals with psoriasis the questionnaire collects information regarding their symptoms and medication use and its effectiveness.

Protocol:

Psoriasis Self Evaluation plus Medication Survey

If affected with psoriasis:

1. Age at which symptoms appeared: _______

2. Age at which psoriasis was diagnosed by a physician: _______

3. Is the physician who diagnosed you a dermatologist:

[ ] Yes

[ ] No

Name of your current dermatologist: _________________________________________

4. If affected with arthritis:

4a. Age at which symptoms appeared: _______

4b. Age at which arthritis was diagnosed by a physician: _______

4c. Have you been told by a rheumatologist that you have psoriatic arthritis?

[ ] Yes

[ ] No

5. Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder?

[ ] Yes

[ ] No

[ ] Explanation:____________________________________________________
              (diagnosis if known, date of diagnosis, doctor who made the diagnosis)

6. Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)?

[ ] Yes

[ ] No

[ ] Explanation:____________________________________________________
              (diagnosis if known, date of diagnosis, doctor who made the diagnosis)

7. Do you have any blood relatives affected with psoriasis?

[ ] Yes

[ ] No

7a. If yes, relationship(s) ___________________________________________

____________________________________________________________________________

8. Do you have any blood relatives with inflammatory bowel disease?

[ ] Yes

[ ] No

[ ] Explanation:_____________________________________________________
              (for each type of relative, please give presumed diagnosis)

9. Do you have any blood relatives with any type of autoimmune disease?

[ ] Yes

[ ] No

[ ] Explanation:_____________________________________________________
              (for each type of relative, please give presumed diagnosis)

STOP HERE IF YOU ARE PARTICIPATING AS A CONTROL AND DO NOT HAVE PSORIASIS.

10. How bad is your psoriasis today?

Please answer each of the following three questions by placing an X mark anywhere on the line to show how red, thick, and scaly an average spot of your psoriasis is.

10A. What color is an average spot of your psoriasis?

    No redness             Slight pink             Pink                     Red                  Dark red

Scale

10B. How thick is an average spot of your psoriasis?

    No thickness             Feels firm            Raised                Thick               Very thick

Scale

10C. How scaly is an average spot of your psoriasis?

           No scale             Slight scale          Scaly                  Flaky                 Very flaky

Scale

10D. Has a dermatologist told you that you have pustular psoriasis?

[ ] Yes

[ ] No

10E. Do you have nail psoriasis (pitting of nail surface, thickened or crumbly nails, excessive separation of the tips of the nails from the nail bed, or yellow-orange spotting of the nails)?

[ ] Yes

[ ] No

10e1.If yes, number of fingernails affected _______; number of toenails affected ________.

11. On the drawings below, mark areas of your body affected with psoriasis NOW. Please also write any explanation you wish to add below the drawings.

Body Image

12. On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Again, feel free to write any explanation you wish to add below the drawings.

Body Image

Psoriasis Medication Usage and Effectiveness History

Alcohol and tobacco usage

13. How many of the following do you smoke per day?

[ ] Cigarettes ______

[ ] Cigars ______

[ ] Pipes ______

14. How many alcoholic drinks do you have per week _________

(one drink = one beer = one glass of wine = one cocktail)

Please mark any of the following medications you are using or have used in the past as appropriate.

Topical medications (creams, lotions etc.)

15. Dovonex®

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

16. Anthralin

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

17. Coal Tar

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

18. Other, please describe: __________________________________________________

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

19. Other, please describe: __________________________________________________

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

Systemic medications (oral medications)

20. Methotrexate

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

21. Soriatane®

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

22. Cyclosporine

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

23. Other, please describe: __________________________________________________

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

Biologicals (injected)

24. Enbrel®

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

25. Humira™

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

26. Raptiva™

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

27. Amevive®

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

28. Remicade®

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

29. Other, please describe: __________________________________________________

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments on any/all biologicals:_____________________________________________________

________________________________________________________________________________

Phototherapy

30. PUVA

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

31. UVB

Usage duration: ____ years ____months

Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:

[ ] 0 not effective

[ ] 1  

[ ] 2  

[ ] 3  

[ ] 4  

[ ] 5 very effective

Comments:_______________________________________________________________________

________________________________________________________________________________

Dovonex® a registered trademark, LEO PHARMA A/S Corporation Denmark No.55 Industriparken Ballerup Denmark DK-2750; Soriatane® a registered trademark, Stiefel Laboratories, Inc.; Enbrel® a registered trademark, Immunex Corporation; Humira ™ a registered trademark, Abbott Laboratories; Raptiva™ a registered trademark, Genentech Inc.; Amevive® a registered trademark, Astellas US LLC; Remicade® a registered trademark, Centocor Ortho Biotech Inc.

Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

Personnel and Training Required

None

Equipment Needs

The respondent will need a copy of the questionnaire.

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Life Stage:

Adult, Senior

Participants:

Adults, older adults

Specific Instructions:

The PhenX Skin, Bone, Muscle and Joint Working Group (WG) recommends that investigators provide participants with an informed consent form which allows future contact for physician validation of their diagnosis and to update information on their health status. Immediately following the alcohol and tobacco questions, the Self Evaluation plus Medication Survey asked questions regarding the respondent's weight and height. These questions have been deleted. The Working Group recommends that this information be obtained via the PhenX measures titled Weight and Height, respectively. These measures are located in the PhenX Toolkit, under the Anthropometrics domain.

Selection Rationale

Although there are various psoriasis instruments, the Self Evaluation plus Medication Survey was selected by the PhenX Skin, Bone, Muscle and Joint Working Group because of its development from the Collaborative Association Study of Psoriasis (CASP), its application for individuals with psoriasis and controls, and its ability to obtain information on the presence of specific diseases within their family.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Skin Psoriasis Personal Medical History Assessment Description Text 3158267 CDE Browser
Common Data Elements (CDE) Skin Psoriasis Family Medical History Assessment Description Text 3158275 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Pers fam hx psoriasis proto 62906-3 LOINC
Derived Variables

None

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

The Self Evaluation plus Medication Survey was provided by the Psoriasis Genetics Laboratory, Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI. Of note, the questions in this survey have been renumbered 1–31.

General References

Nair, R. P., Stuart, P. E., Nistor, I., Hiremagalore, R., Chia, N. V. C., Jenisch, S., Weichenthal, M., Abeasis, G. R., Lim, H. W., Christophers, E., Voorhees, J. J., & Elder, J. T. (2006). Sequence and haplotype analysis supports HLA-C as the Psoriasis Susceptibility 1 gene. American Journal of Human Genetics, 78, 827–851. PMCID: PMC1474031.

Nair, R. P., Ruether, A., Stuart, P. E., Jenisch, S., Tejasvi, T., Hiremagalore, R., Schreiber, S., Kabelitz, D., Lim, H. W., Voorhees, J. J., Christophers, E., Elder, J. T., & Weichenthal, M. (2008). Polymorphisms of the IL12B and IL23R genes are associated with psoriasis. Journal of Investigative Dermatology, 128, 1653–1661. PMCID: PMC2739284.

Nair, R. P., Callis Duffin, K., Helms, C., Ding, J., Stuart, P. E., Goldgar, D., Gudjonsson, J., Li, Y., Tejasvi, T., Feng, B. J., Ruether, A., Schreiber, S., Weichenthal, M., Gladman, D., Rahman, P., Schrodi, S. J., Prahalad, S., Guthery, S. L., Fischer, J., Liao, W., Kwok, P., Menter, A., Lathrop, G. M., Wise, C., Begovich, A. B., Voorhees, J. J., Elder, J. T., Krueger, G. G., Bowcock, A. M., & Abecasis, G. R. (2009). Genome-wide scan of psoriasis reveals association with IL-23 and NF-kB pathways. Nature Genetics, 41(2), 199–204. PMCID: PMC2745122.

de Cid, R., Riveira-Munoz, E., Zeeuwen, P. L. J. M., Robarge, J., Liao, W., Dannhauser, E. N., Giardina, E., Stuart, P. E., Nair, R. P., Helms, C., Escarams, G., Ballana, E., Martn-Ezquerra, G., den Heijer, M., Kamsteeg, M., Joosten, I., Eichler, E. E., Lzaro, C., Pujol, R. M., Armengol, L., Abecasis, G., Elder, J. T., Novelli, G., Armour, J. A. L., Kwok, P., Bowcock, A., Schalkwijk, J., & Estivill, X. (2009). Deletion of the late cornified envelope (LCE) 3B and 3C genes as a susceptibility factor for psoriasis. Nature Genetics, 41(2), 211-215. NIHMSID: NIHMS213228.

Stuart, P. E., Nair, R. P., Hiremagalore, R., Kullavanijaya, P., Kullavanijaya, P., Tejasvi, T., Lim, H. W., Voorhees, J. J., & Elder, J. T. (2010). Comparison of MHC Class I risk haplotypes in Thai and Caucasian psoriatics reveals locus heterogeneity at PSORS1. Tissue Antigens, July 1 [E-pub ahead of print]. NIHMSID: NIHMS215411

Stuart, P. E., Nair, R. P., Ellinghaus, E., Ding, J., Tejasvi, T., Gudjonsson, J. E., Li, Y., Weidinger, S., Eberlein, B., Gieger, C., Wichmann, H. E., Kunz, M., Ike, R., Mroweitz, U., Lim, H. W., Voorhees, J. J., Abecasis, G. R., Weichenthal, M., Franke, A., Rahman, P., Gladman, D., & Elder, J. T. (in press). Genome-wide association analysis identifies three psoriasis susceptibility loci. Nature Genetics.

Protocol ID:

170501

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX170501_Age_Arthritis_Diagnosed PX170501040200 Age at which arthritis was diagnosed by a physician 4 N/A
PX170501_Age_Arthritis_Onset PX170501040100 Age at which symptoms appeared 4 N/A
PX170501_Age_Psoriasis_Diagnosed PX170501020000 Age at which psoriasis was diagnosed by a physician 4 N/A
PX170501_Age_Psoriasis_Onset PX170501010000 Age at which symptoms appeared 4 N/A
PX170501_Amevive_Usage_Comments PX170501270400 Biologicals (injected) Amevive usage comments: 4 N/A
PX170501_Amevive_Usage_Duration_Months PX170501270200 Biologicals (injected) Amevive usage duration - months 4 N/A
PX170501_Amevive_Usage_Duration_Years PX170501270100 Biologicals (injected) Amevive usage duration - years 4 N/A
PX170501_Amevive_Usage_Effectiveness PX170501270300 Biologicals (injected) Amevive usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Anthralin_Usage_Comments PX170501160400 Topical Medications (creams, lotions, etc.) Anthralin usage comments: 4 N/A
PX170501_Anthralin_Usage_Duration_Months PX170501160200 Topical Medications (creams, lotions, etc.) Anthralin usage duration - months 4 N/A
PX170501_Anthralin_Usage_Duration_Years PX170501160100 Topical Medications (creams, lotions, etc.) Anthralin usage duration - years 4 N/A
PX170501_Anthralin_Usage_Effectiveness PX170501160300 Topical Medications (creams, lotions, etc.) Anthralin usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Arthritis_Diagnosed_By_Rheumatologist PX170501040201 Have you been told by a rheumatologist that you have psoriatic arthritis? 4 N/A
PX170501_Autoimmune_Disease PX170501060000 Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? 4 N/A
PX170501_Autoimmune_Disease_Explanation_Date_Day PX170501060202 Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? Explanation (diagnosis if known, date of diagnosis, doctor who made the diagnosis) 4 N/A
PX170501_Autoimmune_Disease_Explanation_Date_Month PX170501060201 Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? Explanation (diagnosis if known, date of diagnosis, doctor who made the diagnosis) 4 N/A
PX170501_Autoimmune_Disease_Explanation_Date_Year PX170501060203 Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? Explanation (diagnosis if known, date of diagnosis, doctor who made the diagnosis) 4 N/A
PX170501_Autoimmune_Disease_Explanation_Diagnosis PX170501060100 Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? Explanation (diagnosis if known, date of diagnosis, doctor who made the diagnosis) 4 N/A
PX170501_Autoimmune_Disease_Explanation_Doctor PX170501060300 Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? Explanation (diagnosis if known, date of diagnosis, doctor who made the diagnosis) 4 N/A
PX170501_Autoimmune_Disease_Family_History PX170501090000 Do you have any blood relatives with any type of autoimmune disease? 4 N/A
PX170501_Autoimmune_Disease_Family_History_Explanation_Diagnosis PX170501090200 Do you have any blood relatives with any type of autoimmune disease? Explanation (for each type of relative, please give presumed diagnosis) 4 N/A
PX170501_Autoimmune_Disease_Family_History_Explanation_Relative PX170501090100 Do you have any blood relatives with any type of autoimmune disease? Explanation (for each type of relative, please give presumed diagnosis) 4 N/A
PX170501_Average_Spot_Of_Psoriasis_Color PX170501100100 What color is an average spot of your psoriasis? (To record color of average spots, treat categories as a four point likert scale where "No redness" = 0 and "Dark red" = 4. Record marks between categories to the nearest tenth of a point) 4 N/A
PX170501_Average_Spot_Of_Psoriasis_Scaliness PX170501100300 How scaly is an average spot of your psoriasis? (To record scaliness of average spots, treat categories as a four point likert scale where "No scale" = 0 and "Very flaky" = 4. Record marks between categories to the nearest tenth of a point) 4 N/A
PX170501_Average_Spot_Of_Psoriasis_Thickness PX170501100200 How thick is an average spot of your psoriasis? (To record thickness of average spots, treat categories as a four point likert scale where "No thickness" = 0 and "Very thick" = 4. Record marks between categories to the nearest tenth of a point) 4 N/A
PX170501_CoalTar_Usage_Comments PX170501170400 Topical Medications (creams, lotions, etc.) Coal tar usage comments: 4 N/A
PX170501_CoalTar_Usage_Duration_Months PX170501170200 Topical Medications (creams, lotions, etc.) Coal tar usage duration - months 4 N/A
PX170501_CoalTar_Usage_Duration_Years PX170501170100 Topical Medications (creams, lotions, etc.) Coal tar usage duration - years 4 N/A
PX170501_CoalTar_Usage_Effectiveness PX170501170300 Topical Medications (creams, lotions, etc.) Coal tar usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Crohns_Disease PX170501050000 Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? 4 N/A
PX170501_Crohns_Disease_Explanation_Date_Day PX170501050202 Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? Explanation: (diagnosis if known, date of diagnosis, doctor who made the diagnosis) 4 N/A
PX170501_Crohns_Disease_Explanation_Date_Month PX170501050201 Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? Explanation: (diagnosis if known, date of diagnosis, doctor who made the diagnosis) 4 N/A
PX170501_Crohns_Disease_Explanation_Date_Year PX170501050203 Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? Explanation: (diagnosis if known, date of diagnosis, doctor who made the diagnosis) 4 N/A
PX170501_Crohns_Disease_Explanation_Diagnosis PX170501050100 Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? Explanation: (diagnosis if known, date of diagnosis, doctor who made the diagnosis) 4 N/A
PX170501_Crohns_Disease_Explanation_Doctor PX170501050300 Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? Explanation: (diagnosis if known, date of diagnosis, doctor who made the diagnosis) 4 N/A
PX170501_Current_Dermatologist_Name PX170501030100 Name of your current dermatologist 4 N/A
PX170501_Cyclosporine_Usage_Comments PX170501220400 Systemic medications (oral medications) Cyclosporine usage comments: 4 N/A
PX170501_Cyclosporine_Usage_Duration_Months PX170501220200 Systemic medications (oral medications) Cyclosporine usage duration - months 4 N/A
PX170501_Cyclosporine_Usage_Duration_Years PX170501220100 Systemic medications (oral medications) Cyclosporine usage duration - years 4 N/A
PX170501_Cyclosporine_Usage_Effectiveness PX170501220300 Systemic medications (oral medications) Cyclosporine usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Dermatologist_Diagnosed_Pustular_Psoriasis PX170501100400 Has a dermatologist told you that you have pustular psoriasis? 4 N/A
PX170501_Dovonex_Usage_Comments PX170501150400 Topical Medications (creams, lotions, etc.) Dovonex usage comments: 4 N/A
PX170501_Dovonex_Usage_Duration_Months PX170501150200 Topical Medications (creams, lotions, etc.) Dovonex usage duration - months 4 N/A
PX170501_Dovonex_Usage_Duration_Years PX170501150100 Topical Medications (creams, lotions, etc.) Dovonex usage duration - years 4 N/A
PX170501_Dovonex_Usage_Effectiveness PX170501150300 Topical Medications (creams, lotions, etc.) Dovonex usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Drinks_Per_Week PX170501140000 How many alcoholic drinks do you have per week (one drink = one beer = one glass of wine = one cocktail) 4 N/A
PX170501_Enbrel_Usage_Comments PX170501240400 Biologicals (injected) Enbrel usage comments: 4 N/A
PX170501_Enbrel_Usage_Duration_Months PX170501240200 Biologicals (injected) Enbrel usage duration - months 4 N/A
PX170501_Enbrel_Usage_Duration_Years PX170501240100 Biologicals (injected) Enbrel usage duration - years 4 N/A
PX170501_Enbrel_Usage_Effectiveness PX170501240300 Biologicals (injected) Enbrel usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Humira_Usage_Comments PX170501250400 Biologicals (injected) Humira usage comments: 4 N/A
PX170501_Humira_Usage_Duration_Months PX170501250200 Biologicals (injected) Humira usage duration - months 4 N/A
PX170501_Humira_Usage_Duration_Years PX170501250100 Biologicals (injected) Humira usage duration - years 4 N/A
PX170501_Humira_Usage_Effectiveness PX170501250300 Biologicals (injected) Humira usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_InflammatoryBowelDisease_Family_History PX170501080000 Do you have any blood relatives with inflammatory bowel disease? 4 N/A
PX170501_InflammatoryBowelDisease_Family_History_Explanation_Diagnosis PX170501080200 Do you have any blood relatives with inflammatory bowel disease? Explanation (for each type of relative, please give presumed diagnosis) 4 N/A
PX170501_InflammatoryBowelDisease_Family_History_Explanation_Relative PX170501080100 Do you have any blood relatives with inflammatory bowel disease? Explanation (for each type of relative, please give presumed diagnosis) 4 N/A
PX170501_Methotrexate_Usage_Comments PX170501200400 Systemic medications (oral medications) Methotrexate usage comments: 4 N/A
PX170501_Methotrexate_Usage_Duration_Months PX170501200200 Systemic medications (oral medications) Methotrexate usage duration - months 4 N/A
PX170501_Methotrexate_Usage_Duration_Years PX170501200100 Systemic medications (oral medications) Methotrexate usage duration - years 4 N/A
PX170501_Methotrexate_Usage_Effectiveness PX170501200300 Systemic medications (oral medications) Methotrexate usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Nail_Psoriasis PX170501100500 Do you have nail psoriasis (pitting of nail surface, thickened or crumbly nails, excessive separation of the tips of the nails from the nail bed, or yellow-orange spotting of the nails)? 4 N/A
PX170501_Nail_Psoriasis_Number_Fingernails_Affected PX170501100600 Do you have nail psoriasis (pitting of nail surface, thickened or crumbly nails, excessive separation of the tips of the nails from the nail bed, or yellow-orange spotting of the nails)? If yes, number of fingernails affected 4 N/A
PX170501_Nail_Psoriasis_Number_Toenails_Affected PX170501100700 Do you have nail psoriasis (pitting of nail surface, thickened or crumbly nails, excessive separation of the tips of the nails from the nail bed, or yellow-orange spotting of the nails)? If yes, number of toenails affected 4 N/A
PX170501_OtherBiological1Usage_Comments PX170501290500 Biologicals (injected) Other usage comments: 4 N/A
PX170501_OtherBiological1Usage_Duration_Months PX170501290300 Biologicals (injected) Other usage duration - months 4 N/A
PX170501_OtherBiological1Usage_Duration_Years PX170501290200 Biologicals (injected) Other usage duration - years 4 N/A
PX170501_OtherBiological1Usage_Effectiveness PX170501290400 Biologicals (injected) Other usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_OtherBiological1_Describe PX170501290100 Biologicals (injected) Other, please describe 4 N/A
PX170501_OtherSystemic1_Usage_Comments PX170501230500 Systemic medications (oral medications) Other usage comments: 4 N/A
PX170501_OtherSystemic1_Usage_Describe PX170501230100 Systemic medications (oral medications) Other, please describe 4 N/A
PX170501_OtherSystemic1_Usage_Duration_Months PX170501230300 Systemic medications (oral medications) Other usage duration - months 4 N/A
PX170501_OtherSystemic1_Usage_Duration_Years PX170501230200 Systemic medications (oral medications) Other usage duration - years 4 N/A
PX170501_OtherSystemic1_Usage_Effectiveness PX170501230400 Systemic medications (oral medications) Other usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_OtherTopical1_Usage_Comments PX170501180500 Topical Medications (creams, lotions, etc.) Other usage comments: 4 N/A
PX170501_OtherTopical1_Usage_Describe PX170501180100 Topical Medications (creams, lotions, etc.) Other , please describe 4 N/A
PX170501_OtherTopical1_Usage_Duration_Months PX170501180300 Topical Medications (creams, lotions, etc.) Other usage duration - months 4 N/A
PX170501_OtherTopical1_Usage_Duration_Years PX170501180200 Topical Medications (creams, lotions, etc.) Other usage duration - years 4 N/A
PX170501_OtherTopical1_Usage_Effectiveness PX170501180400 Topical Medications (creams, lotions, etc.) Other usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_OtherTopical2_Usage_Comments PX170501190500 Topical Medications (creams, lotions, etc.) Other usage comments: 4 N/A
PX170501_OtherTopical2_Usage_Describe PX170501190100 Topical Medications (creams, lotions, etc.) Other , please describe 4 N/A
PX170501_OtherTopical2_Usage_Duration_Months PX170501190300 Topical Medications (creams, lotions, etc.) Other usage duration - months 4 N/A
PX170501_OtherTopical2_Usage_Duration_Years PX170501190200 Topical Medications (creams, lotions, etc.) Other usage duration - years 4 N/A
PX170501_OtherTopical2_Usage_Effectiveness PX170501190400 Topical Medications (creams, lotions, etc.) Other usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLeftFoot PX170501113400 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of left foot 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLeftHand PX170501114600 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of left hand 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLowerLeftArm PX170501114400 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of lower left arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLowerLeftLeg PX170501113200 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of lower left leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLowerRightArm PX170501114200 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of lower right arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLowerRightLeg PX170501113000 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of lower right leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackNeck PX170501110400 On the drawings below, mark areas of your body affected with psoriasis NOW. Back of neck 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackRightFoot PX170501113600 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of right foot 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackRightHand PX170501114800 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of right hand 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackUpperLeftArm PX170501114000 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of upper left arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackUpperLeftLeg PX170501112800 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of upper left leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackUpperRightArm PX170501113800 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of upper right arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackUpperRightLeg PX170501112600 On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of upper right leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterButtock PX170501112200 On the drawings below, mark areas of your body affected with psoriasis NOW. Center of buttocks 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterChest PX170501110700 On the drawings below, mark areas of your body affected with psoriasis NOW. Center of chest 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterGroin PX170501112000 On the drawings below, mark areas of your body affected with psoriasis NOW. Center of groin 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterLowerBack PX170501111700 On the drawings below, mark areas of your body affected with psoriasis NOW. Center of lower back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterStomach PX170501111400 On the drawings below, mark areas of your body affected with psoriasis NOW. Center of stomach 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterUpperBack PX170501111000 On the drawings below, mark areas of your body affected with psoriasis NOW. Center of upper back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_Comments PX170501114900 On the drawings below, mark areas of your body affected with psoriasis NOW. Please also write any explanation you wish to add below the drawings. 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_Face PX170501110100 On the drawings below, mark areas of your body affected with psoriasis NOW. Face 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLeftFoot PX170501113300 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of left foot 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLeftHand PX170501114500 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of left hand 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerLeftArm PX170501114300 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of lower left arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerLeftLeg PX170501113100 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of lower left leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerRightArm PX170501114100 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of lower right arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerRightLeg PX170501112900 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of lower right leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontNeck PX170501110300 On the drawings below, mark areas of your body affected with psoriasis NOW. Front of neck 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontRightFoot PX170501113500 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of right foot 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontRightHand PX170501114700 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of right hand 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperLeftArm PX170501113900 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of upper left arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperLeftLeg PX170501112700 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of upper left leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperRightArm PX170501113700 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of upper right arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperRightLeg PX170501112500 On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of upper right leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftButtock PX170501112400 On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of buttocks 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftChest PX170501110900 On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of chest 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftGroin PX170501115000 On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of groin 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftLowerBack PX170501111900 On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of lower back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftShoulder PX170501110600 On the drawings below, mark areas of your body affected with psoriasis NOW. Left shoulder 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftStomach PX170501111600 On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of stomach 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftUpperBack PX170501111300 On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of upper back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightButtock PX170501112300 On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of buttocks 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightChest PX170501110800 On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of chest 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightGroin PX170501112100 On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of groin 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightLowerBack PX170501111800 On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of lower back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightShoulder PX170501110500 On the drawings below, mark areas of your body affected with psoriasis NOW. Right shoulder 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightStomach PX170501111500 On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of stomach 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightUpperBack PX170501111200 On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of upper back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_Scalp PX170501110200 On the drawings below, mark areas of your body affected with psoriasis NOW. Scalp 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLeftFoot PX170501123400 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of left foot 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLeftHand PX170501124600 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of left hand 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerLeftArm PX170501124400 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of lower left arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerLeftLeg PX170501123200 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of lower left leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerRightArm PX170501124200 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of lower right arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerRightLeg PX170501123000 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of lower right leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackNeck PX170501120400 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back of neck 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackRightFoot PX170501123600 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of right foot 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackRightHand PX170501124800 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of right hand 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperLeftArm PX170501124000 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of upper left arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperLeftLeg PX170501122800 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of upper left leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperRightArm PX170501123800 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of upper right arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperRightLeg PX170501122600 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of upper right leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterButtock PX170501122200 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of buttocks 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterChest PX170501120700 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of chest 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterGroin PX170501122000 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of groin 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterLowerBack PX170501121700 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of lower back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterStomach PX170501121400 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of stomach 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterUpperBack PX170501121000 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of upper back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_Comments PX170501124900 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Please also write any explanation you wish to add below the drawings. 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_Face PX170501120100 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Face 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLeftFoot PX170501123300 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of left foot 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLeftHand PX170501124500 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of left hand 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLowerLeftArm PX170501124300 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of lower left arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLowerLeftLeg PX170501123100 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of lower left leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLowerRightArm PX170501124100 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of lower right arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLowerRightLeg PX170501122900 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of lower right leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontNeck PX170501120300 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front of neck 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontRightFoot PX170501123500 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of right foot 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontRightHand PX170501124700 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of right hand 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontUpperLeftArm PX170501123900 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of upper left arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontUpperLeftLeg PX170501122700 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of upper left leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontUpperRightArm PX170501123700 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of upper right arm 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontUpperRightLeg PX170501122500 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of upper right leg 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftButtock PX170501122400 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of buttocks 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftChest PX170501120900 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of chest 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftGroin PX170501125000 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of groin 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftLowerBack PX170501121900 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of lower back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftShoulder PX170501120600 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left shoulder 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftStomach PX170501121600 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of stomach 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftUpperBack PX170501121300 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of upper back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightButtock PX170501122300 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of buttocks 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightChest PX170501120800 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of chest 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightGroin PX170501122100 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of groin 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightLowerBack PX170501121800 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of lower back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightShoulder PX170501120500 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right shoulder 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightStomach PX170501121500 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of stomach 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightUpperBack PX170501121200 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of upper back 4 N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_Scalp PX170501120200 On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Scalp 4 N/A
PX170501_Psoriasis_Diagnosing_Physician_Dermatologist PX170501030000 Is the physician who diagnosed you a dermatologist: 4 N/A
PX170501_Psoriasis_Family_History PX170501070000 Do you have any blood relatives affected with psoriasis? 4 N/A
PX170501_Psoriasis_Family_History_Relationship PX170501070100 Do you have any blood relatives affected with psoriasis? If yes, relationship(s) 4 N/A
PX170501_PUVA_Usage_Comments PX170501300400 Phototherapy PUVA usage comments: 4 N/A
PX170501_PUVA_Usage_Duration_Months PX170501300200 Phototherapy PUVA usage duration - months 4 N/A
PX170501_PUVA_Usage_Duration_Years PX170501300100 Phototherapy PUVA usage duration - years 4 N/A
PX170501_PUVA_Usage_Effectiveness PX170501300300 Phototherapy PUVA usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Raptiva_Usage_Comments PX170501260400 Biologicals (injected) Raptiva usage comments: 4 N/A
PX170501_Raptiva_Usage_Duration_Months PX170501260200 Biologicals (injected) Raptiva usage duration - months 4 N/A
PX170501_Raptiva_Usage_Duration_Years PX170501260100 Biologicals (injected) Raptiva usage duration - years 4 N/A
PX170501_Raptiva_Usage_Effectiveness PX170501260300 Biologicals (injected) Raptiva usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Remicade_Usage_Comments PX170501280400 Biologicals (injected) Remicade usage comments: 4 N/A
PX170501_Remicade_Usage_Duration_Months PX170501280200 Biologicals (injected) Remicade usage duration - months 4 N/A
PX170501_Remicade_Usage_Duration_Years PX170501280100 Biologicals (injected) Remicade usage duration - years 4 N/A
PX170501_Remicade_Usage_Effectiveness PX170501280300 Biologicals (injected) Remicade usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_Smoke_Cigarettes_NumberPerDay PX170501130100 How many of the following do you smoke per day? Cigarettes 4 N/A
PX170501_Smoke_Cigars_NumberPerDay PX170501130200 How many of the following do you smoke per day? Cigars 4 N/A
PX170501_Smoke_Pipes_NumberPerDay PX170501130300 How many of the following do you smoke per day? Pipes 4 N/A
PX170501_Smoke_Type PX170501130000 How many of the following do you smoke per day? 4 N/A
PX170501_Soriatane_Usage_Comments PX170501210400 Systemic medications (oral medications) Soriatane usage comments: 4 N/A
PX170501_Soriatane_Usage_Duration_Months PX170501210200 Systemic medications (oral medications) Soriatane usage duration - months 4 N/A
PX170501_Soriatane_Usage_Duration_Years PX170501210100 Systemic medications (oral medications) Soriatane usage duration - years 4 N/A
PX170501_Soriatane_Usage_Effectiveness PX170501210300 Systemic medications (oral medications) Soriatane usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
PX170501_UVB_Usage_Comments PX170501310400 Phototherapy UVB usage comments: 4 N/A
PX170501_UVB_Usage_Duration_Months PX170501310200 Phototherapy UVB usage duration - months 4 N/A
PX170501_UVB_Usage_Duration_Years PX170501310100 Phototherapy UVB usage duration - years 4 N/A
PX170501_UVB_Usage_Effectiveness PX170501310300 Phototherapy UVB usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one: 4 N/A
Research Domain Information
Measure Name:

Personal and Family History of Psoriasis

Release Date:

November 12, 2010

Definition

This measure consists of a questionnaire to determine the respondent's personal and family history of psoriasis and other autoimmune diseases, as well as current symptoms and medication use and its effectiveness.

Purpose

Psoriasis is a chronic autoimmune disease of the skin. Psoriasis can also cause joint inflammation, which is known as psoriatic arthritis. Recent evidence suggests that psoriasis is associated with diabetes, hypertension, and coronary artery disease.

Keywords

arthritis, psoriasis, scaly, redness, autoimmune disease, skin, bone, joint