Name

Birth Date

Age

Gender

Male Female

Residency

--< Select >-- Cairo Giza Alexandria Port Said Suez Demiatt Dakahlia Sharkia Qalyoubia Kafr Shaikh Gharbia Menouffia Behaira Ismaillia Beni Suif Fayoum Minia Assuit Sohag Qena Asswan Luxor Al Bahr Al Ahmar Al Wadi Al Gaddid Matrouh N. Sinai S. Sinai Other Country

Occupation

Weight (kg)

Height (m)

BMI (Body Mass Index)

Smoking

Yes No

Informed Consent

Diseases

--< Select >-- Rheumatoid Arthritis SLE Systemic Sclerosis JIA Ankylosing Spondylitis Psoriatic arthritis Enteropathic arthritis Gout Pseudogout Polymyositis Dermatomyositis MCTD Sjogren's $ Antiphospholipid $ Adult onset Still's disease Giant Cell Arteritis (GCA) Takayasu Arteritis (TA) Polyarteritis nodosa (PAN) Kawasaki Wegner disease (GPA) Churg Strauss disease (EGPA) Microscopic Polyangitis (MPA) Behcet Syndrome FMF Amyloidosis

Biological agents

--< Select >-- Humira (Adalimumab) Enbrel (Etanercept) Simponi (Golimumab) Cimzia (Certolizumab) Remicade (Infliximab) Actmera (Tocilizumab) Kineret (Anakinra) Stelara (Ustekinumab) Cosentyx (Secukinumab) Xeljanz (Tofacitinib) Mabthera (Rituximab) Orencia (Abatacept)

Dose

Duration of treatment

Interval between treatment doses

Side effects

Primary failure

Yes No

Switched to (after primary failure)

--< Select >-- Humira (Adalimumab) Enbrel (Etanercept) Simponi (Golimumab) Cimzia (Certolizumab) Remicade (Infliximab) Actmera (Tocilizumab) Kineret (Anakinra) Stelara (Ustekinumab) Cosentyx (Secukinumab) Xeljanz (Tofacitinib) Mabthera (Rituximab) Orencia (Abatacept)

Secondary failure

Yes No

Switched to (after secondary failure)

--< Select >-- Humira (Adalimumab) Enbrel (Etanercept) Simponi (Golimumab) Cimzia (Certolizumab) Remicade (Infliximab) Actmera (Tocilizumab) Kineret (Anakinra) Stelara (Ustekinumab) Cosentyx (Secukinumab) Xeljanz (Tofacitinib) Mabthera (Rituximab) Orencia (Abatacept)