Thank you for your interest in Joined Bio's lupus blood collection study.
To see if you qualify for this study, please fill out the following questionnaire.
Contact and Demographic Information
Study qualification status
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
City and State
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your age?
*
What sex were you assigned at birth?
*
Female
Male
Prefer not to say
Have you been clinically diagnosed with Systemic Lupus Erythematosus (SLE)?s
*
Yes
No
Are you willing to participate in a study requiring an blood collection (about 1.5 ounces) at your home? We will send a trained phlebotomist to you.
*
Yes
No
If selected to take part in this study, are you willing to provide Joined Bio with a copy of your medical records or authorize Joined Bio to retrieve them from your providers?
*
Yes, I am willing to get them myself
Yes, I am willing to authorize Joined Bio to obtain them
No
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Medical Conditions
Please list the medical conditions you have or have had in the past.
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Lupus Appointments and Medications
Have you had a lupus-related doctor's visit (rheumatologist) and blood test in the past 4 weeks?
*
Yes
No
Are you on any treatments for SLE or any other autoimmune conditions?
*
Yes
No
I don't know
Does your treatment include rituxiamb or belimumab?
*
Yes
No
I don't know
Do you take corticosteroids, hydroxychloroquine or anifrolumab?
*
Yes
No
I don't know
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SLEDAI Assessment
This study requires understanding your lupus disease activity and your SLEDAI score. The SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) is a clinical and laboratory scoring tool used by physicians to measure disease activity in patients with SLE.
In the last 4 weeks, did you have a SLEDAI assessment performed at a medical visit?
*
Yes
No
I don't know
What was your SLEDAI Score?
*
<10
10-20
>20
Are you willing to fill out a separate questionnaire to help determine or validate your SLEDAI score as part of the qualification process for this study? It will take about 10 minutes to complete. If yes, you will be directed to complete it at the end of this survey.
*
Yes
No
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Please click the submit button to record your responses.
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