Rheumatoid Arthritis Clinical Trial Screening Checklist
Patient Information
Patient Name
Date of Birth
Medical Record Number
Eligibility Criteria
Diagnosis of Rheumatoid Arthritis
Yes
Duration of Disease (months/years)
Age (18 - 75 years)
Seropositive (RF/Anti-CCP)
RF
Anti-CCP
Swollen Joint Count (SJC) ≥ 6
Tender Joint Count (TJC) ≥ 6
Elevated CRP/ESR
CRP
ESR
Current DMARDs
Exclusion Criteria
Other Autoimmune Diseases
Present
Active Infection
Present
History of Malignancy
Present
Pregnant or Breastfeeding
Yes
Additional Notes
Comments