Rheumatoid Arthritis Questionnaire

If you are interested in participating in the Rheumatoid Arthritis Component of the 13th IHWC please fill in the boxes and click submit when finished.

J. Lee Nelson, USA (FAX: 206-667-6969) Chair
Jean-Francois Eliaou, France (FAX: 33-467-33-71-29) Co-chair

Name

Organization

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Work Phone

FAX

E-mail

12th IHWC lab code:
if you know it

Rheumatology Clinical Center

Name of the associated clinician:
Institution

Characterization of the patients
(following items are requested and will be entered for each patient included in the study):

age at disease onset, sex, history of blood transfusion, duration of the disease
ethnic background
affected sibs, affected twins, living parents (father, mother)
radiographs and/or report of radiographs of hands and wrists, erosions and/or joint space narrowing, rheumatoid factor, extra-articular manifestations
functional assessment of disability
medical treatments, surgical treatment

Number of patients (clinical information required, see above)

Are your samples:

already collected?
how many?

already typed for class I?
how many?

already typed for class II?
how many?

How many samples will be typed for class I

at the end of 1998?

at the end of 1999?

How many samples will be typed for class II

at the end of 1998?

at the end of 1999?

Are your already collected samples available as:

DNA
frozen lymphocytes
B lymphoblastoid cell lines

Families (pedigree charts required)

Simplex families (one affected child with both living parents)

already collected?
how many?

will be typed for class I and II at the end of 1999
how many?

Multiplex families (more than one affected child with both living parents)

already collected?
how many?

will be typed for class I and II at the end of 1999
how many?

Families with affected or non-affected twins

already collected?
how many?

will be typed for class I and II at the end of 1999
how many?

Unrelated Controls

Is an ethnically HLA-matched control group available?

Yes No

Is a control group:

already collected
how many?

to be typed for class I and II at the end of 1999
how many?

Typings

Class I typings:

serology DNA-based

Class II subtypings;

Yes No

Microsatellite typings:

Yes No

if yes, for what purpose was microsatellite typing done?

if no, would you be ready to do microsatellite typing?

Yes No

if no, would you accept sending your samples to other labs?

Yes No

Other MHC gene typing?

Do you have access to an automated DNA sequencer?

Yes No

what type?

Comments

Last revised: October 28, 1999

Name
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail