Loading…

Protocol - Personal and Family History of Psoriasis

Add to Toolkit

Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

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

[img[psorasis_scale.png|Scale]]

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

    No thickness             Feels firm            Raised                Thick               Very thick

[img[psorasis_scale.png|Scale]]

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

           No scale             Slight scale          Scaly                  Flaky                 Very flaky

[img[psorasis_scale.png|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.

[img[Psorasis_Clinical_Evaluation_body_image.jpg|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.

[img[Psorasis_Clinical_Evaluation_body_image.jpg|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.

Personnel and Training Required

None

Equipment Needs

The respondent will need a copy of the questionnaire.

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Adult, Senior

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.

Research Domain Information

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.

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 Family Medical History Assessment Description Text3158275CDE Browser
Common Data Elements (CDE)Skin Psoriasis Personal Medical History Assessment Description Text3158267CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Pers fam hx psoriasis proto62906-3LOINC

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_Psoriasis_OnsetPX170501010000Age at which symptoms appeared4N/A
PX170501_Age_Psoriasis_DiagnosedPX170501020000Age at which psoriasis was diagnosed by a physician4N/A
PX170501_Psoriasis_Diagnosing_Physician_DermatologistPX170501030000Is the physician who diagnosed you a dermatologist:4N/A
PX170501_Current_Dermatologist_NamePX170501030100Name of your current dermatologist4N/A
PX170501_Age_Arthritis_OnsetPX170501040100Age at which symptoms appeared4N/A
PX170501_Age_Arthritis_DiagnosedPX170501040200Age at which arthritis was diagnosed by a physician4N/A
PX170501_Arthritis_Diagnosed_By_RheumatologistPX170501040201Have you been told by a rheumatologist that you have psoriatic arthritis?4N/A
PX170501_Crohns_DiseasePX170501050000Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder?4N/A
PX170501_Crohns_Disease_Explanation_DiagnosisPX170501050100Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? Explanation: (diagnosis if known, date of diagnosis, doctor who made the diagnosis)4N/A
PX170501_Crohns_Disease_Explanation_Date_MonthPX170501050201Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? Explanation: (diagnosis if known, date of diagnosis, doctor who made the diagnosis)4N/A
PX170501_Crohns_Disease_Explanation_Date_DayPX170501050202Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? Explanation: (diagnosis if known, date of diagnosis, doctor who made the diagnosis)4N/A
PX170501_Crohns_Disease_Explanation_Date_YearPX170501050203Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? Explanation: (diagnosis if known, date of diagnosis, doctor who made the diagnosis)4N/A
PX170501_Crohns_Disease_Explanation_DoctorPX170501050300Have you been diagnosed with Crohn's disease or another inflammatory bowel disorder? Explanation: (diagnosis if known, date of diagnosis, doctor who made the diagnosis)4N/A
PX170501_Autoimmune_DiseasePX170501060000Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)?4N/A
PX170501_Autoimmune_Disease_Explanation_DiagnosisPX170501060100Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? Explanation (diagnosis if known, date of diagnosis, doctor who made the diagnosis)4N/A
PX170501_Autoimmune_Disease_Explanation_Date_MonthPX170501060201Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? Explanation (diagnosis if known, date of diagnosis, doctor who made the diagnosis)4N/A
PX170501_Autoimmune_Disease_Explanation_Date_DayPX170501060202Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? Explanation (diagnosis if known, date of diagnosis, doctor who made the diagnosis)4N/A
PX170501_Autoimmune_Disease_Explanation_Date_YearPX170501060203Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? Explanation (diagnosis if known, date of diagnosis, doctor who made the diagnosis)4N/A
PX170501_Autoimmune_Disease_Explanation_DoctorPX170501060300Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)? Explanation (diagnosis if known, date of diagnosis, doctor who made the diagnosis)4N/A
PX170501_Psoriasis_Family_HistoryPX170501070000Do you have any blood relatives affected with psoriasis?4N/A
PX170501_Psoriasis_Family_History_RelationshipPX170501070100Do you have any blood relatives affected with psoriasis? If yes, relationship(s)4N/A
PX170501_InflammatoryBowelDisease_Family_HistoryPX170501080000Do you have any blood relatives with inflammatory bowel disease?4N/A
PX170501_InflammatoryBowelDisease_Family_History_Explanation_RelativePX170501080100Do you have any blood relatives with inflammatory bowel disease? Explanation (for each type of relative, please give presumed diagnosis)4N/A
PX170501_InflammatoryBowelDisease_Family_History_Explanation_DiagnosisPX170501080200Do you have any blood relatives with inflammatory bowel disease? Explanation (for each type of relative, please give presumed diagnosis)4N/A
PX170501_Autoimmune_Disease_Family_HistoryPX170501090000Do you have any blood relatives with any type of autoimmune disease?4N/A
PX170501_Autoimmune_Disease_Family_History_Explanation_RelativePX170501090100Do you have any blood relatives with any type of autoimmune disease? Explanation (for each type of relative, please give presumed diagnosis)4N/A
PX170501_Autoimmune_Disease_Family_History_Explanation_DiagnosisPX170501090200Do you have any blood relatives with any type of autoimmune disease? Explanation (for each type of relative, please give presumed diagnosis)4N/A
PX170501_Average_Spot_Of_Psoriasis_ColorPX170501100100What 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)4N/A
PX170501_Average_Spot_Of_Psoriasis_ThicknessPX170501100200How 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)4N/A
PX170501_Average_Spot_Of_Psoriasis_ScalinessPX170501100300How 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)4N/A
PX170501_Dermatologist_Diagnosed_Pustular_PsoriasisPX170501100400Has a dermatologist told you that you have pustular psoriasis?4N/A
PX170501_Nail_PsoriasisPX170501100500Do 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)?4N/A
PX170501_Nail_Psoriasis_Number_Fingernails_AffectedPX170501100600Do 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 affected4N/A
PX170501_Nail_Psoriasis_Number_Toenails_AffectedPX170501100700Do 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 affected4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FacePX170501110100On the drawings below, mark areas of your body affected with psoriasis NOW. Face4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_ScalpPX170501110200On the drawings below, mark areas of your body affected with psoriasis NOW. Scalp4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontNeckPX170501110300On the drawings below, mark areas of your body affected with psoriasis NOW. Front of neck4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackNeckPX170501110400On the drawings below, mark areas of your body affected with psoriasis NOW. Back of neck4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightShoulderPX170501110500On the drawings below, mark areas of your body affected with psoriasis NOW. Right shoulder4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftShoulderPX170501110600On the drawings below, mark areas of your body affected with psoriasis NOW. Left shoulder4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterChestPX170501110700On the drawings below, mark areas of your body affected with psoriasis NOW. Center of chest4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightChestPX170501110800On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of chest4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftChestPX170501110900On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of chest4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterUpperBackPX170501111000On the drawings below, mark areas of your body affected with psoriasis NOW. Center of upper back4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightUpperBackPX170501111200On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of upper back4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftUpperBackPX170501111300On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of upper back4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterStomachPX170501111400On the drawings below, mark areas of your body affected with psoriasis NOW. Center of stomach4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightStomachPX170501111500On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of stomach4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftStomachPX170501111600On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of stomach4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterLowerBackPX170501111700On the drawings below, mark areas of your body affected with psoriasis NOW. Center of lower back4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightLowerBackPX170501111800On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of lower back4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftLowerBackPX170501111900On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of lower back4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterGroinPX170501112000On the drawings below, mark areas of your body affected with psoriasis NOW. Center of groin4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightGroinPX170501112100On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of groin4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CenterButtockPX170501112200On the drawings below, mark areas of your body affected with psoriasis NOW. Center of buttocks4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_RightButtockPX170501112300On the drawings below, mark areas of your body affected with psoriasis NOW. Right side of buttocks4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftButtockPX170501112400On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of buttocks4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperRightLegPX170501112500On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of upper right leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackUpperRightLegPX170501112600On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of upper right leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperLeftLegPX170501112700On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of upper left leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackUpperLeftLegPX170501112800On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of upper left leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerRightLegPX170501112900On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of lower right leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLowerRightLegPX170501113000On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of lower right leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerLeftLegPX170501113100On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of lower left leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLowerLeftLegPX170501113200On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of lower left leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLeftFootPX170501113300On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of left foot4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLeftFootPX170501113400On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of left foot4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontRightFootPX170501113500On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of right foot4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackRightFootPX170501113600On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of right foot4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperRightArmPX170501113700On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of upper right arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackUpperRightArmPX170501113800On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of upper right arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperLeftArmPX170501113900On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of upper left arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackUpperLeftArmPX170501114000On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of upper left arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerRightArmPX170501114100On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of lower right arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLowerRightArmPX170501114200On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of lower right arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerLeftArmPX170501114300On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of lower left arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLowerLeftArmPX170501114400On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of lower left arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLeftHandPX170501114500On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of left hand4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackLeftHandPX170501114600On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of left hand4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_FrontRightHandPX170501114700On the drawings below, mark areas of your body affected with psoriasis NOW. Front side of right hand4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_BackRightHandPX170501114800On the drawings below, mark areas of your body affected with psoriasis NOW. Back side of right hand4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_CommentsPX170501114900On the drawings below, mark areas of your body affected with psoriasis NOW. Please also write any explanation you wish to add below the drawings.4N/A
PX170501_Psoriasis_BodyAreas_AffectedNow_LeftGroinPX170501115000On the drawings below, mark areas of your body affected with psoriasis NOW. Left side of groin4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FacePX170501120100On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Face4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_ScalpPX170501120200On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Scalp4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontNeckPX170501120300On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front of neck4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackNeckPX170501120400On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back of neck4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightShoulderPX170501120500On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right shoulder4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftShoulderPX170501120600On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left shoulder4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterChestPX170501120700On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of chest4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightChestPX170501120800On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of chest4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftChestPX170501120900On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of chest4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterUpperBackPX170501121000On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of upper back4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightUpperBackPX170501121200On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of upper back4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftUpperBackPX170501121300On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of upper back4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterStomachPX170501121400On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of stomach4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightStomachPX170501121500On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of stomach4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftStomachPX170501121600On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of stomach4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterLowerBackPX170501121700On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of lower back4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightLowerBackPX170501121800On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of lower back4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftLowerBackPX170501121900On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of lower back4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterGroinPX170501122000On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of groin4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightGroinPX170501122100On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of groin4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterButtockPX170501122200On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Center of buttocks4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_RightButtockPX170501122300On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Right side of buttocks4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftButtockPX170501122400On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of buttocks4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontUpperRightLegPX170501122500On 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 leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperRightLegPX170501122600On 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 leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontUpperLeftLegPX170501122700On 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 leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperLeftLegPX170501122800On 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 leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLowerRightLegPX170501122900On 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 leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerRightLegPX170501123000On 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 leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLowerLeftLegPX170501123100On 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 leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerLeftLegPX170501123200On 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 leg4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLeftFootPX170501123300On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of left foot4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLeftFootPX170501123400On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of left foot4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontRightFootPX170501123500On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of right foot4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackRightFootPX170501123600On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of right foot4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontUpperRightArmPX170501123700On 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 arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperRightArmPX170501123800On 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 arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontUpperLeftArmPX170501123900On 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 arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperLeftArmPX170501124000On 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 arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLowerRightArmPX170501124100On 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 arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerRightArmPX170501124200On 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 arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLowerLeftArmPX170501124300On 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 arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerLeftArmPX170501124400On 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 arm4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontLeftHandPX170501124500On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of left hand4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLeftHandPX170501124600On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of left hand4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontRightHandPX170501124700On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Front side of right hand4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_BackRightHandPX170501124800On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Back side of right hand4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_CommentsPX170501124900On 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.4N/A
PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftGroinPX170501125000On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Left side of groin4N/A
PX170501_Smoke_TypePX170501130000How many of the following do you smoke per day?4N/A
PX170501_Smoke_Cigarettes_NumberPerDayPX170501130100How many of the following do you smoke per day? Cigarettes4N/A
PX170501_Smoke_Cigars_NumberPerDayPX170501130200How many of the following do you smoke per day? Cigars4N/A
PX170501_Smoke_Pipes_NumberPerDayPX170501130300How many of the following do you smoke per day? Pipes4N/A
PX170501_Drinks_Per_WeekPX170501140000How many alcoholic drinks do you have per week (one drink = one beer = one glass of wine = one cocktail)4N/A
PX170501_Dovonex_Usage_Duration_YearsPX170501150100Topical Medications (creams, lotions, etc.) Dovonex usage duration - years4N/A
PX170501_Dovonex_Usage_Duration_MonthsPX170501150200Topical Medications (creams, lotions, etc.) Dovonex usage duration - months4N/A
PX170501_Dovonex_Usage_EffectivenessPX170501150300Topical Medications (creams, lotions, etc.) Dovonex usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_Dovonex_Usage_CommentsPX170501150400Topical Medications (creams, lotions, etc.) Dovonex usage comments:4N/A
PX170501_Anthralin_Usage_Duration_YearsPX170501160100Topical Medications (creams, lotions, etc.) Anthralin usage duration - years4N/A
PX170501_Anthralin_Usage_Duration_MonthsPX170501160200Topical Medications (creams, lotions, etc.) Anthralin usage duration - months4N/A
PX170501_Anthralin_Usage_EffectivenessPX170501160300Topical Medications (creams, lotions, etc.) Anthralin usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_Anthralin_Usage_CommentsPX170501160400Topical Medications (creams, lotions, etc.) Anthralin usage comments:4N/A
PX170501_CoalTar_Usage_Duration_YearsPX170501170100Topical Medications (creams, lotions, etc.) Coal tar usage duration - years4N/A
PX170501_CoalTar_Usage_Duration_MonthsPX170501170200Topical Medications (creams, lotions, etc.) Coal tar usage duration - months4N/A
PX170501_CoalTar_Usage_EffectivenessPX170501170300Topical Medications (creams, lotions, etc.) Coal tar usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_CoalTar_Usage_CommentsPX170501170400Topical Medications (creams, lotions, etc.) Coal tar usage comments:4N/A
PX170501_OtherTopical1_Usage_DescribePX170501180100Topical Medications (creams, lotions, etc.) Other , please describe4N/A
PX170501_OtherTopical1_Usage_Duration_YearsPX170501180200Topical Medications (creams, lotions, etc.) Other usage duration - years4N/A
PX170501_OtherTopical1_Usage_Duration_MonthsPX170501180300Topical Medications (creams, lotions, etc.) Other usage duration - months4N/A
PX170501_OtherTopical1_Usage_EffectivenessPX170501180400Topical Medications (creams, lotions, etc.) Other usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_OtherTopical1_Usage_CommentsPX170501180500Topical Medications (creams, lotions, etc.) Other usage comments:4N/A
PX170501_OtherTopical2_Usage_DescribePX170501190100Topical Medications (creams, lotions, etc.) Other , please describe4N/A
PX170501_OtherTopical2_Usage_Duration_YearsPX170501190200Topical Medications (creams, lotions, etc.) Other usage duration - years4N/A
PX170501_OtherTopical2_Usage_Duration_MonthsPX170501190300Topical Medications (creams, lotions, etc.) Other usage duration - months4N/A
PX170501_OtherTopical2_Usage_EffectivenessPX170501190400Topical Medications (creams, lotions, etc.) Other usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_OtherTopical2_Usage_CommentsPX170501190500Topical Medications (creams, lotions, etc.) Other usage comments:4N/A
PX170501_Methotrexate_Usage_Duration_YearsPX170501200100Systemic medications (oral medications) Methotrexate usage duration - years4N/A
PX170501_Methotrexate_Usage_Duration_MonthsPX170501200200Systemic medications (oral medications) Methotrexate usage duration - months4N/A
PX170501_Methotrexate_Usage_EffectivenessPX170501200300Systemic medications (oral medications) Methotrexate usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_Methotrexate_Usage_CommentsPX170501200400Systemic medications (oral medications) Methotrexate usage comments:4N/A
PX170501_Soriatane_Usage_Duration_YearsPX170501210100Systemic medications (oral medications) Soriatane usage duration - years4N/A
PX170501_Soriatane_Usage_Duration_MonthsPX170501210200Systemic medications (oral medications) Soriatane usage duration - months4N/A
PX170501_Soriatane_Usage_EffectivenessPX170501210300Systemic medications (oral medications) Soriatane usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_Soriatane_Usage_CommentsPX170501210400Systemic medications (oral medications) Soriatane usage comments:4N/A
PX170501_Cyclosporine_Usage_Duration_YearsPX170501220100Systemic medications (oral medications) Cyclosporine usage duration - years4N/A
PX170501_Cyclosporine_Usage_Duration_MonthsPX170501220200Systemic medications (oral medications) Cyclosporine usage duration - months4N/A
PX170501_Cyclosporine_Usage_EffectivenessPX170501220300Systemic medications (oral medications) Cyclosporine usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_Cyclosporine_Usage_CommentsPX170501220400Systemic medications (oral medications) Cyclosporine usage comments:4N/A
PX170501_OtherSystemic1_Usage_DescribePX170501230100Systemic medications (oral medications) Other, please describe4N/A
PX170501_OtherSystemic1_Usage_Duration_YearsPX170501230200Systemic medications (oral medications) Other usage duration - years4N/A
PX170501_OtherSystemic1_Usage_Duration_MonthsPX170501230300Systemic medications (oral medications) Other usage duration - months4N/A
PX170501_OtherSystemic1_Usage_EffectivenessPX170501230400Systemic medications (oral medications) Other usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_OtherSystemic1_Usage_CommentsPX170501230500Systemic medications (oral medications) Other usage comments:4N/A
PX170501_Enbrel_Usage_Duration_YearsPX170501240100Biologicals (injected) Enbrel usage duration - years4N/A
PX170501_Enbrel_Usage_Duration_MonthsPX170501240200Biologicals (injected) Enbrel usage duration - months4N/A
PX170501_Enbrel_Usage_EffectivenessPX170501240300Biologicals (injected) Enbrel usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_Enbrel_Usage_CommentsPX170501240400Biologicals (injected) Enbrel usage comments:4N/A
PX170501_Humira_Usage_Duration_YearsPX170501250100Biologicals (injected) Humira usage duration - years4N/A
PX170501_Humira_Usage_Duration_MonthsPX170501250200Biologicals (injected) Humira usage duration - months4N/A
PX170501_Humira_Usage_EffectivenessPX170501250300Biologicals (injected) Humira usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_Humira_Usage_CommentsPX170501250400Biologicals (injected) Humira usage comments:4N/A
PX170501_Raptiva_Usage_Duration_YearsPX170501260100Biologicals (injected) Raptiva usage duration - years4N/A
PX170501_Raptiva_Usage_Duration_MonthsPX170501260200Biologicals (injected) Raptiva usage duration - months4N/A
PX170501_Raptiva_Usage_EffectivenessPX170501260300Biologicals (injected) Raptiva usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_Raptiva_Usage_CommentsPX170501260400Biologicals (injected) Raptiva usage comments:4N/A
PX170501_Amevive_Usage_Duration_YearsPX170501270100Biologicals (injected) Amevive usage duration - years4N/A
PX170501_Amevive_Usage_Duration_MonthsPX170501270200Biologicals (injected) Amevive usage duration - months4N/A
PX170501_Amevive_Usage_EffectivenessPX170501270300Biologicals (injected) Amevive usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_Amevive_Usage_CommentsPX170501270400Biologicals (injected) Amevive usage comments:4N/A
PX170501_Remicade_Usage_Duration_YearsPX170501280100Biologicals (injected) Remicade usage duration - years4N/A
PX170501_Remicade_Usage_Duration_MonthsPX170501280200Biologicals (injected) Remicade usage duration - months4N/A
PX170501_Remicade_Usage_EffectivenessPX170501280300Biologicals (injected) Remicade usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_Remicade_Usage_CommentsPX170501280400Biologicals (injected) Remicade usage comments:4N/A
PX170501_OtherBiological1_DescribePX170501290100Biologicals (injected) Other, please describe4N/A
PX170501_OtherBiological1Usage_Duration_YearsPX170501290200Biologicals (injected) Other usage duration - years4N/A
PX170501_OtherBiological1Usage_Duration_MonthsPX170501290300Biologicals (injected) Other usage duration - months4N/A
PX170501_OtherBiological1Usage_EffectivenessPX170501290400Biologicals (injected) Other usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_OtherBiological1Usage_CommentsPX170501290500Biologicals (injected) Other usage comments:4N/A
PX170501_PUVA_Usage_Duration_YearsPX170501300100Phototherapy PUVA usage duration - years4N/A
PX170501_PUVA_Usage_Duration_MonthsPX170501300200Phototherapy PUVA usage duration - months4N/A
PX170501_PUVA_Usage_EffectivenessPX170501300300Phototherapy PUVA usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_PUVA_Usage_CommentsPX170501300400Phototherapy PUVA usage comments:4N/A
PX170501_UVB_Usage_Duration_YearsPX170501310100Phototherapy UVB usage duration - years4N/A
PX170501_UVB_Usage_Duration_MonthsPX170501310200Phototherapy UVB usage duration - months4N/A
PX170501_UVB_Usage_EffectivenessPX170501310300Phototherapy UVB usage effectiveness on 0-5 scale (0 = not effective, 5 = very effective), please circle one:4N/A
PX170501_UVB_Usage_CommentsPX170501310400Phototherapy UVB usage comments:4N/A