Alkem

Patient No *

Patient Initials *

Date of Enrollment *

Age (in Years) *

Gender *

Male Female Other

Height (in cm) *

Weight (in Kg) *

Smoking Status *

Current Smoker Former Smoker Non-Smoker

Duration of Rheumatoid Arthritis (years) *

Previous Treatments *

Methotrexate Other DMARDs

Biologic Agents

Date of Tofacitinib Initiation *

Tofacitinib Dosage (mg/day) *

Concomitant Medications *

Methotrexate Other DMARDs

NSAIDs Corticosteroids Any other

Morning Stiffness *

Duration (minutes/hours)
Severity (0-10)

Joint Pain Intensity (0-10) *

Daily Activity Level (0-10) *

Quality of Life Assessment (0-10)

Adverse Events *

Yes No

Additional Comments/Notes

Demographic Information