Questionnaire for patient data.
| Demographics and JIA Type | Questions on Medications Used | Questions on IBD |
|---|---|---|
| Initials | When was MTX started/stopped | Date start IBD symptoms: |
| Date of birth | Sulfasalazine given? When started/stopped? | What was the medication at time of onset of gastrointestinal complaints? |
| Gender | Steroids (when started, what dosage)/start/stop | Aspect of stools: blood/mucus/normal |
| Age of onset JIA | When was etanercept, infliximab, adalimumab or anakinra started (date) | Daily frequency of stools |
| Subtype JIA | Dosage etanercept | Weight loss/failure to thrive |
| Family history JIA | Did JIA symptoms improve after starting etanercept | Laboratory examinations: HLA-B27; Blood film, ESR, CRP, OT, PT, LDH, albumin |
| HLA-B27 | Fecal blood/increased protein excretion (for instance alpha 1 antitrypsin) | |
| Biopsy proven (date) | ||
| What was the pathology report | ||
| Date stop etanercept/infliximab/adalimumab/anakinra | ||
| How and when (date) was the IBD further treated | ||
| Steroid dose and duration of treatment; did GI symptoms improve under steroids or did symptoms develop after stopping steroids? | ||
| Treatment response | ||
| Date of disappearance of IBD symptoms: |