What is your age? < 40 years > 40 years

What is your gender? Female     Male

Do you have a relative diagnosed with rheumatoid arthritis?     Yes     No

(If Female) Have you given birth or lost a pregnancy within the last year?     Yes     No

Have you recently developed pain in your hands or feet in the past year?     Yes     No

Have you noticed any swelling of the joints in your hands, wrists, elbows or feet in the past year?     Yes     No

Do you notice that your joints are stiff for more than 45 minutes when you awaken after a long sleep in the absence of taking any medicine for your symptoms?     Yes     No

Have you tried an anti-inflammatory medication and noticed improvement of your symptoms?     Yes     No

Has your doctor told you that you have a positive blood test for rheumatoid arthritis?     Yes     No

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