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What Are Your Concerns and Challenges Regarding RA and Its Treatment?
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1.
Have you been diagnosed with RA?
(Required.)
Yes
No
No, but I am a caregiver for a patient with RA
No, but I have many of the symptoms associated with RA
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2.
How long ago were you diagnosed with RA?
(Required.)
< 1 year
1 to 5 years
3 to 5 years
> 5 years
I have not been diagnosed with RA
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3.
Please indicate your sex
(Required.)
Female
Male
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4.
Please indicate your age
(Required.)
Under 18 years
18-24 years
25-40 years
41-64 years
65-74 years
Over 74 years
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5.
What treatments are you currently using to manage your RA? (Select all that apply)
(Required.)
Lifestyle modification (e.g., diet, exercise, no smoking, etc.)
Non-steroid anti-inflammatory drug (NSAID; e.g., aspirin, ibuprofen, naproxen)
Corticosteroid (e.g., dexamethasone, methylprednisone)
Trexall or Rasuvo (methotrexate)
Biologic therapy (e.g., Humira [adalimumab], Actemra [tocilizumab], Remicade [infliximab], Rituxan [rituximab], etc.)
Other oral agent (e.g., Xelijanz [tofacitinib])
Biosimilar (e.g., adalimumab-atto brand name Amjevita)
I am not currently being treated for RA
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6.
Which of the following statements best reflects your level of satisfaction with your current treatment?
(Required.)
Extremely satisfied
Satisfied
Somewhat satisfied
Not satisfied
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7.
What would you change about your current treatment?
(Required.)
Nothing
Better symptom control
Fewer side effects
Reduced dosing frequency
I would prefer injectable therapy over oral therapy
I would prefer oral therapy over injectable therapy
Other (please specify)
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8.
What are your main concerns regarding your RA and treatment (select 3)?
(Required.)
Chronic pain
Inability to perform activities of daily living (ADLs) (e.g., walking, dressing, eating)
Decreased ability to work
Lack of effective treatments
Lack of access to a specialist
Treatment side effects
Cost of medications
Formulary restrictions
Other (please specify)
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9.
Would the following improve your satisfaction with care (Yes, No, Already Utilize, N/A)?
(Required.)
Yes
No
Already Utilize
N/A
Patient-focused education materials
Yes
No
Already Utilize
N/A
Access to a specialist in my area
Yes
No
Already Utilize
N/A
More treatment options
Yes
No
Already Utilize
N/A
Patient advocacy network
Yes
No
Already Utilize
N/A
Patient web portal to access my healthcare team
Yes
No
Already Utilize
N/A
Tools to improve medication adherence
Yes
No
Already Utilize
N/A
Other: Please specify
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10.
Please provide any additional comments regarding concerns with your RA or its treatment below:
(Required.)