Rheumatoid Arthritis / Inflammatory Arthritis Annual Review Form

If you have been advised by the practice to complete a Rheumatoid Arthritis / Inflammatory Arthritis Annual Review please use this form.

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Patient's Details
Blood Pressure (If able to record at home)
Lifestyle
Your Personal Alcohol Consumption

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Audit Score Result

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If you are drinking less than 14 units of alcohol per week, then your drinking is within the UK Chief Medical Officers' low risk drinking guidelines.

But if you are drinking regularly at or above the low risk guidelines of 14 units a week, or, you are drinking six or more units - if you are female - or eight or more units - if you are male - in one single session (binge drinking), please consider the increased serious risks to your health being caused by your current drinking pattern.

How does your illness affect your ability to function in daily life? In the last week how would you rate your ability to do each of the following tasks?
We are also interested in learning whether or not you are affected by pain because of your illness
 
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Can you tell us how well managed your arthritis is at the moment?
Over the last 2 weeks, how often have you been bothered by the following problems?
 
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Please ensure you are happy with the required monitoring checks for your medication;

Sulfasalazine- Every 2 weeks until on stable dose for 6 weeks. Once on stable dose, monthly blood tests for 3 months. Thereafter, at least every 12 weeks for 12 months, then no routine monitoring needed.

Methotrexate – Every 2 weeks until on stable dose for 6 weeks. Once on stable dose, monthly blood tests for 3 months. Thereafter, at least every 12 weeks.

Penicillamine – Blood test and urinalysis every 2 weeks until dose stable for 3 months and then monthly.

Leflunomide – Every 2 weeks until on stable dose for 6 weeks. Once on stable dose, monthly blood tests for 3 months. Thereafter, at least every 12 weeks.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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