Protocol - Personal and Family History of Psoriasis
- Arthritis/Osteoarthritis
- Eczema
- Medications (Current and Past Use of Pain Relievers, Statins, and Steroids)
- Systemic Lupus Erythematosus
Description
The Self Evaluation plus Medication Survey is a self-administered instrument which was developed from the questionnaires used in the Collaborative Association Study of Psoriasis (CASP), which is a Genetic Association Information Network (GAIN) genome-wide association study (GWAS). The Self Evaluation plus Medication Survey collects information on individuals with psoriasis and controls, and their family history of psoriasis and other autoimmune diseases. Additionally, for individuals with psoriasis the questionnaire collects information regarding their symptoms and medication use and its effectiveness.
Specific Instructions
The PhenX Skin, Bone, Muscle and Joint Working Group (WG) recommends that investigators provide participants with an informed consent form which allows future contact for physician validation of their diagnosis and to update information on their health status. Immediately following the alcohol and tobacco questions, the Self Evaluation plus Medication Survey asked questions regarding the respondents weight and height. These questions have been deleted. The Working Group recommends that this information be obtained via the PhenX measures titled Weight and Height, respectively. These measures are located in the PhenX Toolkit, under the Anthropometrics domain.
Availability
This protocol is freely available; permission not required for use.
Protocol
Psoriasis Self Evaluation plus Medication Survey
If affected with psoriasis:
1. Age at which symptoms appeared: _______
2. Age at which psoriasis was diagnosed by a physician: _______
3. Is the physician who diagnosed you a dermatologist:
[ ] Yes
[ ] No
Name of your current dermatologist: _________________________________________
4. If affected with arthritis:
4a. Age at which symptoms appeared: _______
4b. Age at which arthritis was diagnosed by a physician: _______
4c. Have you been told by a rheumatologist that you have psoriatic arthritis?
[ ] Yes
[ ] No
5. Have you been diagnosed with Crohns disease or another inflammatory bowel disorder?
[ ] Yes
[ ] No
[ ] Explanation:____________________________________________________
(diagnosis if known, date of diagnosis, doctor who made the diagnosis)
6. Have you been diagnosed with any type of autoimmune disease (lupus, scleroderma, etc.)?
[ ] Yes
[ ] No
[ ] Explanation:____________________________________________________
(diagnosis if known, date of diagnosis, doctor who made the diagnosis)
7. Do you have any blood relatives affected with psoriasis?
[ ] Yes
[ ] No
7a. If yes, relationship(s) ___________________________________________
____________________________________________________________________________
8. Do you have any blood relatives with inflammatory bowel disease?
[ ] Yes
[ ] No
[ ] Explanation:_____________________________________________________
(for each type of relative, please give presumed diagnosis)
9. Do you have any blood relatives with any type of autoimmune disease?
[ ] Yes
[ ] No
[ ] Explanation:_____________________________________________________
(for each type of relative, please give presumed diagnosis)
STOP HERE IF YOU ARE PARTICIPATING AS A CONTROL AND DO NOT HAVE PSORIASIS.
10. How bad is your psoriasis today?
Please answer each of the following three questions by placing an X mark anywhere on the line to show how red, thick, and scaly an average spot of your psoriasis is.
10A. What color is an average spot of your psoriasis?
No redness Slight pink Pink Red Dark red
10B. How thick is an average spot of your psoriasis?
No thickness Feels firm Raised Thick Very thick
10C. How scaly is an average spot of your psoriasis?
No scale Slight scale Scaly Flaky Very flaky
10D. Has a dermatologist told you that you have pustular psoriasis?
[ ] Yes
[ ] No
10E. Do you have nail psoriasis (pitting of nail surface, thickened or crumbly nails, excessive separation of the tips of the nails from the nail bed, or yellow-orange spotting of the nails)?
[ ] Yes
[ ] No
10e1.If yes, number of fingernails affected _______; number of toenails affected ________.
11. On the drawings below, mark areas of your body affected with psoriasis NOW. Please also write any explanation you wish to add below the drawings.
12. On the drawings below, mark areas of your body affected with psoriasis WHEN IT WAS THE WORST IT HAS EVER BEEN. Again, feel free to write any explanation you wish to add below the drawings.
Psoriasis Medication Usage and Effectiveness History
Alcohol and tobacco usage
13. How many of the following do you smoke per day?
[ ] Cigarettes ______
[ ] Cigars ______
[ ] Pipes ______
14. How many alcoholic drinks do you have per week _________
(one drink = one beer = one glass of wine = one cocktail)
Please mark any of the following medications you are using or have used in the past as appropriate.
Topical medications (creams, lotions etc.)
15. Dovonex®
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
16. Anthralin
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
17. Coal Tar
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
18. Other, please describe: __________________________________________________
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
19. Other, please describe: __________________________________________________
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
Systemic medications (oral medications)
20. Methotrexate
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
21. Soriatane®
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
22. Cyclosporine
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
23. Other, please describe: __________________________________________________
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
Biologicals (injected)
24. Enbrel®
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
25. Humira™
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
26. Raptiva™
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
27. Amevive®
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
28. Remicade®
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
29. Other, please describe: __________________________________________________
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments on any/all biologicals:_____________________________________________________
________________________________________________________________________________
Phototherapy
30. PUVA
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
31. UVB
Usage duration: ____ years ____months
Effectiveness on 0–5 scale (0 = not effective, 5 = very effective), please circle one:
0[ ]not effective
1[ ]
2[ ]
3[ ]
4[ ]
5[ ]very effective
Comments:_______________________________________________________________________
________________________________________________________________________________
Dovonex® a registered trademark, LEO PHARMA A/S Corporation Denmark No.55 Industriparken Ballerup Denmark DK-2750; Soriatane® a registered trademark, Stiefel Laboratories, Inc.; Enbrel® a registered trademark, Immunex Corporation; Humira ™ a registered trademark, Abbott Laboratories; Raptiva™ a registered trademark, Genentech Inc.; Amevive® a registered trademark, Astellas US LLC; Remicade® a registered trademark, Centocor Ortho Biotech Inc.
Personnel and Training Required
None
Equipment Needs
The respondent will need a copy of the questionnaire.
Requirements
| Requirement Category | Required |
|---|---|
| Major equipment | No |
| Specialized training | No |
| Specialized requirements for biospecimen collection | No |
| Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Self-administered questionnaire
Lifestage
Adult, Senior
Participants
Adults, older adults
Selection Rationale
Although there are various psoriasis instruments, the Self Evaluation plus Medication Survey was selected by the PhenX Skin, Bone, Muscle and Joint Working Group because of its development from the Collaborative Association Study of Psoriasis (CASP), its application for individuals with psoriasis and controls, and its ability to obtain information on the presence of specific diseases within their family.
Language
Chinese, English
Standards
| Standard | Name | ID | Source |
|---|---|---|---|
| Logical Observation Identifiers Names and Codes (LOINC) | Pers fam hx psoriasis proto | 62906-3 | LOINC |
| Human Phenotype Ontology | Psoriasis | HP:0003765 | HPO |
| caDSR Form | PhenX PX170501 - Personal And Family History Of Psoriasis | 6186591 | caDSR Form |
Derived Variables
None
Process and Review
Not applicable.
Protocol Name from Source
Collaborative Association Study of Psoriasis (CASP), Self Evaluation plus Medication Survey
Source
The Self Evaluation plus Medication Survey was provided by the Psoriasis Genetics Laboratory, Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI. Of note, the questions in this survey have been renumbered 1–31.
General References
Nair, R. P., Stuart, P. E., Nistor, I., Hiremagalore, R., Chia, N. V. C., Jenisch, S., Weichenthal, M., Abeasis, G. R., Lim, H. W., Christophers, E., Voorhees, J. J., & Elder, J. T. (2006). Sequence and haplotype analysis supports HLA-C as the Psoriasis Susceptibility 1 gene. American Journal of Human Genetics, 78, 827–851. PMCID: PMC1474031.
Nair, R. P., Ruether, A., Stuart, P. E., Jenisch, S., Tejasvi, T., Hiremagalore, R., Schreiber, S., Kabelitz, D., Lim, H. W., Voorhees, J. J., Christophers, E., Elder, J. T., & Weichenthal, M. (2008). Polymorphisms of the IL12B and IL23R genes are associated with psoriasis. Journal of Investigative Dermatology, 128, 1653–1661. PMCID: PMC2739284.
Nair, R. P., Callis Duffin, K., Helms, C., Ding, J., Stuart, P. E., Goldgar, D., Gudjonsson, J., Li, Y., Tejasvi, T., Feng, B. J., Ruether, A., Schreiber, S., Weichenthal, M., Gladman, D., Rahman, P., Schrodi, S. J., Prahalad, S., Guthery, S. L., Fischer, J., Liao, W., Kwok, P., Menter, A., Lathrop, G. M., Wise, C., Begovich, A. B., Voorhees, J. J., Elder, J. T., Krueger, G. G., Bowcock, A. M., & Abecasis, G. R. (2009). Genome-wide scan of psoriasis reveals association with IL-23 and NF-kB pathways. Nature Genetics, 41(2), 199–204. PMCID: PMC2745122.
de Cid, R., Riveira-Munoz, E., Zeeuwen, P. L. J. M., Robarge, J., Liao, W., Dannhauser, E. N., Giardina, E., Stuart, P. E., Nair, R. P., Helms, C., Escarams, G., Ballana, E., Martn-Ezquerra, G., den Heijer, M., Kamsteeg, M., Joosten, I., Eichler, E. E., Lzaro, C., Pujol, R. M., Armengol, L., Abecasis, G., Elder, J. T., Novelli, G., Armour, J. A. L., Kwok, P., Bowcock, A., Schalkwijk, J., & Estivill, X. (2009). Deletion of the late cornified envelope (LCE) 3B and 3C genes as a susceptibility factor for psoriasis. Nature Genetics, 41(2), 211-215. NIHMSID: NIHMS213228.
Stuart, P. E., Nair, R. P., Hiremagalore, R., Kullavanijaya, P., Kullavanijaya, P., Tejasvi, T., Lim, H. W., Voorhees, J. J., & Elder, J. T. (2010). Comparison of MHC Class I risk haplotypes in Thai and Caucasian psoriatics reveals locus heterogeneity at PSORS1. Tissue Antigens, July 1 [E-pub ahead of print]. NIHMSID: NIHMS215411
Stuart, P. E., Nair, R. P., Ellinghaus, E., Ding, J., Tejasvi, T., Gudjonsson, J. E., Li, Y., Weidinger, S., Eberlein, B., Gieger, C., Wichmann, H. E., Kunz, M., Ike, R., Mroweitz, U., Lim, H. W., Voorhees, J. J., Abecasis, G. R., Weichenthal, M., Franke, A., Rahman, P., Gladman, D., & Elder, J. T. (in press). Genome-wide association analysis identifies three psoriasis susceptibility loci. Nature Genetics.
Protocol ID
170501
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX170501_Age_Arthritis_Diagnosed | ||||
| PX170501040200 | Age at which arthritis was diagnosed by a more | Variable Mapping | ||
| PX170501_Age_Psoriasis_Diagnosed | ||||
| PX170501020000 | Age at which psoriasis was diagnosed by a more | N/A | ||
| PX170501_Amevive_Usage_Comments | ||||
| PX170501270400 | Biologicals (injected) Amevive usage comments: | N/A | ||
| PX170501_Amevive_Usage_Duration_Months | ||||
| PX170501270200 | Biologicals (injected) Amevive usage more | N/A | ||
| PX170501_Anthralin_Usage_Duration_Years | ||||
| PX170501160100 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_Anthralin_Usage_Effectiveness | ||||
| PX170501160300 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_Autoimmune_Disease | ||||
| PX170501060000 | Have you been diagnosed with any type of more | Variable Mapping | ||
| PX170501_Autoimmune_Disease_Explanation_Date_Month | ||||
| PX170501060201 | Have you been diagnosed with any type of more | N/A | ||
| PX170501_Autoimmune_Disease_Explanation_Date_Year | ||||
| PX170501060203 | Have you been diagnosed with any type of more | N/A | ||
| PX170501_Autoimmune_Disease_Family_History_Explanation_Relative | ||||
| PX170501090100 | Do you have any blood relatives with any more | N/A | ||
| PX170501_Average_Spot_Of_Psoriasis_Color | ||||
| PX170501100100 | What color is an average spot of your more | N/A | ||
| PX170501_Average_Spot_Of_Psoriasis_Scaliness | ||||
| PX170501100300 | How scaly is an average spot of your more | N/A | ||
| PX170501_CoalTar_Usage_Duration_Years | ||||
| PX170501170100 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_CoalTar_Usage_Effectiveness | ||||
| PX170501170300 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_Crohns_Disease | ||||
| PX170501050000 | Have you been diagnosed with Crohn's disease more | Variable Mapping | ||
| PX170501_Crohns_Disease_Explanation_Date_Month | ||||
| PX170501050201 | Have you been diagnosed with Crohn's disease more | N/A | ||
| PX170501_Crohns_Disease_Explanation_Date_Year | ||||
| PX170501050203 | Have you been diagnosed with Crohn's disease more | Variable Mapping | ||
| PX170501_Current_Dermatologist_Name | ||||
| PX170501030100 | Name of your current dermatologist | N/A | ||
| PX170501_Cyclosporine_Usage_Duration_Years | ||||
| PX170501220100 | Systemic medications (oral medications) more | N/A | ||
| PX170501_Cyclosporine_Usage_Effectiveness | ||||
| PX170501220300 | Systemic medications (oral medications) more | N/A | ||
| PX170501_Dovonex_Usage_Duration_Years | ||||
| PX170501150100 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_Dovonex_Usage_Effectiveness | ||||
| PX170501150300 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_Enbrel_Usage_Comments | ||||
| PX170501240400 | Biologicals (injected) Enbrel usage comments: | N/A | ||
| PX170501_Enbrel_Usage_Duration_Months | ||||
| PX170501240200 | Biologicals (injected) Enbrel usage duration more | N/A | ||
| PX170501_Humira_Usage_Comments | ||||
| PX170501250400 | Biologicals (injected) Humira usage comments: | N/A | ||
| PX170501_Humira_Usage_Duration_Months | ||||
| PX170501250200 | Biologicals (injected) Humira usage duration more | N/A | ||
| PX170501_InflammatoryBowelDisease_Family_History | ||||
| PX170501080000 | Do you have any blood relatives with more | Variable Mapping | ||
| PX170501_InflammatoryBowelDisease_Family_History_Explanation_Diagnosis | ||||
| PX170501080200 | Do you have any blood relatives with more | N/A | ||
| PX170501_Methotrexate_Usage_Duration_Years | ||||
| PX170501200100 | Systemic medications (oral medications) more | N/A | ||
| PX170501_Methotrexate_Usage_Effectiveness | ||||
| PX170501200300 | Systemic medications (oral medications) more | N/A | ||
| PX170501_Nail_Psoriasis | ||||
| PX170501100500 | Do you have nail psoriasis (pitting of nail more | Variable Mapping | ||
| PX170501_Nail_Psoriasis_Number_Toenails_Affected | ||||
| PX170501100700 | Do you have nail psoriasis (pitting of nail more | N/A | ||
| PX170501_OtherBiological1Usage_Duration_Years | ||||
| PX170501290200 | Biologicals (injected) Other usage duration more | N/A | ||
| PX170501_OtherBiological1Usage_Effectiveness | ||||
| PX170501290400 | Biologicals (injected) Other usage more | N/A | ||
| PX170501_OtherSystemic1_Usage_Comments | ||||
| PX170501230500 | Systemic medications (oral medications) more | N/A | ||
| PX170501_OtherSystemic1_Usage_Describe | ||||
| PX170501230100 | Systemic medications (oral medications) more | N/A | ||
| PX170501_OtherSystemic1_Usage_Duration_Months | ||||
| PX170501230300 | Systemic medications (oral medications) more | N/A | ||
| PX170501_OtherTopical1_Usage_Comments | ||||
| PX170501180500 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_OtherTopical1_Usage_Describe | ||||
| PX170501180100 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_OtherTopical1_Usage_Duration_Months | ||||
| PX170501180300 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_OtherTopical2_Usage_Duration_Years | ||||
| PX170501190200 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_OtherTopical2_Usage_Effectiveness | ||||
| PX170501190400 | Topical Medications (creams, lotions, etc.) more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_BackNeck | ||||
| PX170501110400 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_CenterLowerBack | ||||
| PX170501111700 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_CenterUpperBack | ||||
| PX170501111000 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_Comments | ||||
| PX170501114900 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLeftFoot | ||||
| PX170501113300 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLeftHand | ||||
| PX170501114500 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerLeftArm | ||||
| PX170501114300 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerLeftLeg | ||||
| PX170501113100 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerRightArm | ||||
| PX170501114100 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontLowerRightLeg | ||||
| PX170501112900 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontRightFoot | ||||
| PX170501113500 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontRightHand | ||||
| PX170501114700 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperLeftArm | ||||
| PX170501113900 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperLeftLeg | ||||
| PX170501112700 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperRightArm | ||||
| PX170501113700 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_FrontUpperRightLeg | ||||
| PX170501112500 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_LeftLowerBack | ||||
| PX170501111900 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_LeftShoulder | ||||
| PX170501110600 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_LeftUpperBack | ||||
| PX170501111300 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_RightButtock | ||||
| PX170501112300 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_RightChest | ||||
| PX170501110800 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_RightGroin | ||||
| PX170501112100 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_RightStomach | ||||
| PX170501111500 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedNow_Scalp | ||||
| PX170501110200 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLeftFoot | ||||
| PX170501123400 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLeftHand | ||||
| PX170501124600 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerLeftArm | ||||
| PX170501124400 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerLeftLeg | ||||
| PX170501123200 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerRightArm | ||||
| PX170501124200 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackLowerRightLeg | ||||
| PX170501123000 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackRightFoot | ||||
| PX170501123600 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackRightHand | ||||
| PX170501124800 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperLeftArm | ||||
| PX170501124000 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperLeftLeg | ||||
| PX170501122800 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperRightArm | ||||
| PX170501123800 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_BackUpperRightLeg | ||||
| PX170501122600 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterButtock | ||||
| PX170501122200 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterChest | ||||
| PX170501120700 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterGroin | ||||
| PX170501122000 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_CenterStomach | ||||
| PX170501121400 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_Face | ||||
| PX170501120100 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_FrontNeck | ||||
| PX170501120300 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftButtock | ||||
| PX170501122400 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftChest | ||||
| PX170501120900 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftGroin | ||||
| PX170501125000 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_LeftStomach | ||||
| PX170501121600 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_RightLowerBack | ||||
| PX170501121800 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_RightShoulder | ||||
| PX170501120500 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_BodyAreas_AffectedWorst_RightUpperBack | ||||
| PX170501121200 | On the drawings below, mark areas of your more | N/A | ||
| PX170501_Psoriasis_Family_History | ||||
| PX170501070000 | Do you have any blood relatives affected more | Variable Mapping | ||
| PX170501_PUVA_Usage_Duration_Years | ||||
| PX170501300100 | Phototherapy PUVA usage duration - years | N/A | ||
| PX170501_PUVA_Usage_Effectiveness | ||||
| PX170501300300 | Phototherapy PUVA usage effectiveness on 0-5 more | N/A | ||
| PX170501_Raptiva_Usage_Comments | ||||
| PX170501260400 | Biologicals (injected) Raptiva usage comments: | N/A | ||
| PX170501_Raptiva_Usage_Duration_Months | ||||
| PX170501260200 | Biologicals (injected) Raptiva usage more | N/A | ||
| PX170501_Remicade_Usage_Comments | ||||
| PX170501280400 | Biologicals (injected) Remicade usage comments: | N/A | ||
| PX170501_Remicade_Usage_Duration_Months | ||||
| PX170501280200 | Biologicals (injected) Remicade usage more | N/A | ||
| PX170501_Smoke_Cigarettes_NumberPerDay | ||||
| PX170501130100 | How many of the following do you smoke per more | Variable Mapping | ||
| PX170501_Smoke_Pipes_NumberPerDay | ||||
| PX170501130300 | How many of the following do you smoke per more | Variable Mapping | ||
| PX170501_Soriatane_Usage_Duration_Years | ||||
| PX170501210100 | Systemic medications (oral medications) more | N/A | ||
| PX170501_Soriatane_Usage_Effectiveness | ||||
| PX170501210300 | Systemic medications (oral medications) more | N/A | ||
| PX170501_UVB_Usage_Duration_Years | ||||
| PX170501310100 | Phototherapy UVB usage duration - years | N/A | ||
| PX170501_UVB_Usage_Effectiveness | ||||
| PX170501310300 | Phototherapy UVB usage effectiveness on 0-5 more | N/A | ||
Measure Name
Personal and Family History of Psoriasis
Release Date
November 12, 2010
Definition
This measure consists of a questionnaire to determine the respondent's personal and family history of psoriasis and other autoimmune diseases, as well as current symptoms and medication use and its effectiveness.
Purpose
Psoriasis is a chronic autoimmune disease of the skin. Psoriasis can also cause joint inflammation, which is known as psoriatic arthritis. Recent evidence suggests that psoriasis is associated with diabetes, hypertension, and coronary artery disease.
Keywords
arthritis, psoriasis, scaly, redness, autoimmune disease, skin
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 170501 | Personal and Family History of Psoriasis |