Step 1 of 4 25% Name* First Last Desired Username* Desired Password* Email* My relationship to arthritis is:*- Select One -PatientHealthcare ProfessionalFamily, Friend, or CaregiverBirthday MM slash DD slash YYYY Gender- Select One -FemaleMalePrefer Not to AnswerI am interested in: CreakyJoints Newsletter Advocacy Alerts Recall Alerts Research Opportunities #CreakyChats Reminders Country- Select One -AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code Have you been diagnosed by a physician with an arthritis-related condition?*YesNoI Don't KnowWhich of the following arthritis-related conditions have you been diagnosed with? Please select all that apply Ankylosing spondylitis Fibromyalgia Gout Inflammatory Bowel Disease Juvenile Idiopathic Arthritis Myositis Osteoarthritis Osteoporosis Psoriasis Psoriatic Arthritis Rheumatoid Arthritis Scleroderma Other Condition Which of the following prescription medications do you take for your arthritis-related condition? Please select all that apply A biologic medication given by injection (for example, adalimumab/Humira®, golimumab/Simponi®, etanercept/Enbrel®, certolizumab pegol/Cimzia®, sarilumab/Kevzara®, tocilizumab/Actemra®, anakinra/Kineret® and abatacept/Orencia®) A biologic medication given by infusion (for example, infliximab/Remicade®, tocilizumab/Actemra® infusion, infliximab-dyyb/Inflectra®, infliximab-abda/Renflexis®, rituximab/Rituxan®, abatacept/Orencia® infusion, and golimumab/Simponi Aria®) A conventional synthetic DMARD (for example, methotrexate, hydroxychloroquine/Plaquenil®, sulfasalazine/Azulfidine®, leflunomide/Arava®, azathioprine/Imuran®) A targeted synthetic DMARD (for example, tofacitinib citrate/Xeljanz®/Xeljanz XR® and baricitinib/Olumiant®) A steroid medication (for example, prednisone, betamethasone, budesonide, hydrocortisone, prednisolone, prednisone, triamcinolone) A prescription NSAID (for example, ibuprofen, naproxen, celecoxib/Celebrex®, meloxicam/Mobic®, and diclofenac/Voltaren®) Opioid pain medications (for example, Percocet®, morphine, and oxycodone) Other prescription pain medications (for example, gabapentin) Prescription sleep medications (for example, zolpidem/Ambien®) Other prescription medication Which healthcare provider(s) have you seen to treat and/or care for your arthritis-related condition? Please select all that apply Rheumatologist General practitioner/family doctor Nurse Practitioner Physician’s Assistant Nurse/Registered Nurse Allied health professionals (i.e., dietitian/nutritionist, physical therapist, clinical psychologist, medical assistant, occupational therapist, social worker) Pharmacist What form of health insurance do you have?Medicare and/or MedicaidOther government insurance (e.g., Tricare, CHAMPVA)Private insurance (purchased privately or through and employer)OtherI don’t have health insuranceI don’t knowWhich of the following best describes your racial/ethnic background? Please select all that apply American Indian/Alaska Native Asian Black/African/African American Native Hawaiian/Other Pacific Islander White Multiracial Other/Not listed How would you describe your current employment status? Please select all that apply Employed full-time Employed part-time Self-employed Student Stay-at-home parent/homemaker On sick leave, worker’s compensation leave or other leave Unemployed Retired Disabled Other
