SL. No

Question

Option

Skip

1

How old are you?

0 - 5 years = 1

6 - 10 years = 2

11 - 16 years = 3

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2

Sex

Male = 1

Female = 2

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3

What is your father occupation?

Businessman = 1

Service = 2

Others = 3

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4

Average monthly income?

<10,000 = 1

10,000 - 20,000 = 2

20,000 - 30,000 = 3

>30,000 = 4

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5

How old were you when the disease started?

Years □ Month □

6

How long are you suffering from the disease?

<1 years = 1

1 - 2 years = 2

>2 years = 3

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7

Type of JIA?

Refractory sJIA