Rheumatoid Arthritis Disease Activity Questionnaire
Please complete the Rheumatoid Arthritis Disease Activity Questionnaire Form to help assess your current disease activity and related symptoms.
Overall, how would you rate your current rheumatoid arthritis disease activity?
*
1
2
3
4
5
6
7
8
9
10
How severe was your joint pain in the past week?
*
No pain
0
1
2
3
4
5
6
7
8
9
Worst imaginable pain
10
0 is No pain, 10 is Worst imaginable pain
How long did morning stiffness last today?
*
Please Select
No stiffness
Less than 30 minutes
30–60 minutes
More than 60 minutes
How much fatigue have you experienced in the past week?
*
None
0
1
2
3
4
5
6
7
8
9
Extreme fatigue
10
0 is None, 10 is Extreme fatigue
Which of the following joints are currently swollen? (Select all that apply)
*
Fingers
Wrists
Elbows
Shoulders
Knees
Ankles
Other
How would you rate your ability to perform daily activities?
*
No difficulty
0
1
2
3
4
5
6
7
8
9
Unable to perform
10
0 is No difficulty, 10 is Unable to perform
Please indicate the severity of the following symptoms over the past week.
*
Rows
None
Mild
Moderate
Severe
Joint tenderness
1
2
3
4
Joint swelling
5
6
7
8
Fatigue
9
10
11
12
Pain at rest
13
14
15
16
In the past week, how many days did you experience significant joint swelling?
*
How would you describe your overall physical function today?
*
No limitation
Mild limitation
Moderate limitation
Severe limitation
Please provide any additional comments about your rheumatoid arthritis symptoms.
Submit
Should be Empty: