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| Physical activity: | ||||||
| 301 | Do you do physical activities? 1. YES |__| NO|__| What duration? <30 mins |__| 30 m - 1 h |__| 1 h - 1 h 30 |__| >2 h |__| | |__| |
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| 302 | At what frequency? 1. Once/week|__| 2. Twice/week|__| 3. Trice/week |__| 4. Daily |__| | |__| |
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| 303 | What level of physical activity do you do during your leisure time? 1. Mild |__| 2. Moderate |__| 3. High|__| | |__| |
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| Drug history | |||||||
| 401 | When did you start taking medications for Rheumatoid arthritis? |
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| 402 | Which of the following medications do you take? 1. Methotrexate |__| 2. Aziathropine |__| 3. Cyclosporine |__| D-Penicillamine |__| 4. Sulfasalazine |__| 5. Hydroxychloroquine |__| 6. Minocycline|__| 7. Leflunomide|__| 8. Infliximab |__| 9. Etanercept |__| 10. Corticosteroid |__| 11. NSAIDs|__| | |__| |
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| 403 | Are there other medications you take routinely? Yes |__| No |__| if yes please state them | |__| |
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| Disease Activity Score (DAS) |__| |
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| 404 | Number of tender joints: Number of swollen joints: CRP/ESR: Patient global health/10 |
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| SECTION III: ANTHROPOMETRIC AND BLOOD PRESSURE MEASUREMENTS |
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| 501 | Weight …………kg; Height…………. m|__| BMI: Underweight, normal, overweight, obese, |
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| 502 | waist circumference …………………….cm abdominal obesity YES/NO |
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| 503 | Average clinic Systolic Blood pressure……………..mmHg |
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| 504 | Average clinic Diastolic Blood pressure…………………mmHg |
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| 505 | Heart rate………………………………..beats/min |
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| 506 | Pulse pressure |
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| PWA | |||||||
| 601 | PWV |
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| 602 | Have arterial stiffness? YES/NO |
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| 603 | Aix |
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| 604 | Aix: Normal, increased |
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| 605 | Central pulse pressure |
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| 606 | Central blood pressure |
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| SECTION 4: PARA-CLINICAL INVESTIGATIONS | |||||||
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701 | CRP: Range normal/high |
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| 702 | Fasting Capillary glycemia: Range hypo, normal, glucose intolerance, hyperglycemia |
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