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1.
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Has a doctor ever told you that you have arthritis?
 
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2.
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During the past 12 months, have you had pain, aching, stiffness or swelling in or around a joint?
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3.
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In a typical month, were these symptoms present daily
for at least half of the days in that month?
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4.
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Do you have pain in your knee or hip when climbing
stairs or walking 2-3 blocks (¼ mile) on flat ground?
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5.
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Do you have daily pain or stiffness in your hand joints?
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6.
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Are you now limited in any way in any activities because of joint symptoms (pain, aching, stiffness, loss of motion)?
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7.
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Because of joint symptoms, rate your ability to do the following:
 - Without ANY difficulty
 - With SOME difficulty
 - With MUCH difficulty
 - Unable to do
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a.
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Dress yourself, including shoelaces and buttons?
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b.
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Stand up from an armless, straight chair?
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c.
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Get in and out of a car?
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d.
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Open a car door?
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