Basic data & demographics

Full name* Email address* Phone (optional)

Previous Next

Disease history — timeline

Primary diagnosis* — Select —Rheumatoid arthritis (RA)Psoriatic arthritis (PsA)Systemic lupus erythematosus (SLE)Axial spondyloarthritis / ASJuvenile idiopathic arthritis (JIA)Coeliac diseaseHashimoto’s thyroiditisGraves’ diseaseOther (specify below) If “Other”, specify / Describe your first symptoms Was the diagnosis clear from the start? — Select —YesNo — another condition was suspected first If not, what were the other suspected conditions? (optional)

Previous Next

Current clinical status & quality of life

Overall disease activity (0–10) Pain level (0–10) Fatigue level (0–10) Current symptoms (select all that apply) Joint painJoint swellingMorning stiffnessFatigue / low energyFever / subfebrileSkin changes (rash, scaling, erythema)Muscle painSleep disturbancesConcentration problems / brain fogGastrointestinal symptoms (abdominal pain, diarrhoea, constipation)Eye symptoms (dryness, inflammation)Other (describe below) Flares frequency — Select —None / very rare1–2 times per yearSeveral times per quarterMonthly or more oftenContinuous flare

Patient-Reported Outcomes (screeners)

PHQ-2 (last 2 weeks)

Little interest or pleasure in doing things 0 — Not at all1 — Several days2 — More than half the days3 — Nearly every day Feeling down, depressed, or hopeless 0 — Not at all1 — Several days2 — More than half the days3 — Nearly every day

GAD-2 (last 2 weeks)

Feeling nervous, anxious or on edge 0 — Not at all1 — Several days2 — More than half the days3 — Nearly every day Not being able to stop or control worrying 0 — Not at all1 — Several days2 — More than half the days3 — Nearly every day

PROMIS Global Health-10

General health5 — Excellent4 — Very good3 — Good2 — Fair1 — Poor Quality of life5 — Excellent4 — Very good3 — Good2 — Fair1 — Poor Physical health5 — Excellent4 — Very good3 — Good2 — Fair1 — Poor Mental health5 — Excellent4 — Very good3 — Good2 — Fair1 — Poor Satisfaction with social activities5 — Excellent4 — Very good3 — Good2 — Fair1 — Poor Ability to do everyday physical activities5 — Completely4 — Mostly3 — Moderately2 — A little1 — Not at all Emotional problems (anxious/depressed/irritable)5 — Never4 — Rarely3 — Sometimes2 — Often1 — Always General health (past 7 days)5 — Excellent4 — Very good3 — Good2 — Fair1 — Poor

Work & daily activities (last 7 days)

Previous Next

Treatment — effectiveness & reactions

Current treatment (check all that apply) NSAIDsSteroids (e.g., prednisolone)csDMARDs (e.g., methotrexate)Biologics (e.g., TNF/IL-6 inhibitors)JAK inhibitorsOther (specify below)

Treatment history (add up to 3 lines; attach a file for longer history)

Treatment line 1

Drug name

From

To

Effectiveness (0–10)

Reason for discontinuation— Select —Lack of efficacySide effectsPhysician decisionOther

Side effects (if any)

Treatment line 2

Drug name

From

To

Effectiveness (0–10)

Reason for discontinuation— Select —Lack of efficacySide effectsPhysician decisionOther

Side effects (if any)

Treatment line 3

Drug name

From

To

Effectiveness (0–10)

Reason for discontinuation— Select —Lack of efficacySide effectsPhysician decisionOther

Side effects (if any)

Previous Next

Laboratory results & comorbidities

Comorbidities (select all that apply) HypertensionDiabetes (Type 1)Diabetes (Type 2)High cholesterolNon-autoimmune thyroid diseaseCoeliac diseaseDepression / anxietyFibromyalgiaIrritable bowel syndrome (IBS)Other (specify below) Other relevant results (CBC, liver enzymes, HLA-B27, imaging, etc.) Upload files (results / discharge letters) — PDF/JPG/PNG, up to 5 MB

Previous Next

Environmental factors & lifestyle

History of infections

Diet (select all that apply) Traditional / omnivorousVegetarianVeganGluten-freeLactose-freeOther (describe below)

Family history

Autoimmune disease in immediate family? — Select —YesNo If yes — relation and disease [group ra-group]

RA module — RADAI-5

0–10 scale (0 = none/best; 10 = worst)

Current arthritis activity Arthritis activity past 6 months Arthritis pain past week Arthritis pain past 6 months Morning stiffness duration (minutes) [/group] [group axspa-group]

AxSpA module — BASDAI

0–10 numeric rating

Fatigue Spinal pain Joint pain/swelling Areas tender to touch or pressure Morning stiffness — severity Morning stiffness — duration (0–10; 0 = 0 min, 10 = >2 h) [/group] [group psa-group]

PsA module — PsAID-12 (0–10 impact)

Pain Fatigue Skin problems Work and/or leisure activities Functional capacity Discomfort Sleep disturbance Coping Anxiety Embarrassment/shame Social participation Depression [/group]

Previous Next

Consents & logistics

Additional notes I agree to be contacted by the Hesperion team regarding the project. I agree I confirm I have read the Privacy Policy and consent to the anonymous processing of my medical data for research and scientific purposes within the Hesperion project. I can request access to or deletion of my data as permitted by law.

Previous Next