Self-Testing Questionnaire

Stony Brook Medicine
Rheumatology, Allery & Immunology

Self-Testing Questionnaire for Yao  syndrome and some other autoinflammatory diseases

Fever off and on? Yes No
Rash off and on? Yes No
Rash on cold exposure off and on? Yes No
Rash on sun exposure off and on? Yes No
Joint pain off and on? Yes No
Lower leg, ankle or foot swelling off and on? Yes No
Stomach pain and/or diarrhea off and on? Yes No
Chest pain off and on? Yes No
Dry eyes and/or mouth off and on? Yes No
Red eyes off and on? Yes No
Eye lid swelling and discoloration off and on? Yes No
Mouth ulcers/sores off and on? Yes No
Hearing decrease or loss? Yes No
Swollen glands off and on? Yes No
Flu-like symptoms off and on? Yes No
Asthma off and on? Yes No
Raised Inflammation markers Yes No
kidney stones off and on? Yes No
Do any family members experience fever and/or rash? Yes No
Lupus, rheumatoid arthritis, primary Sjogren's syndrome or vasculitis markers Yes No
Colonoscopy result for Crohn's disease/ulcerative colitis

Please print and bring with you to your doctors appointment.

If you have some symptoms without lupus, rheumatoid arthritis, primary Sjogren's syndrome, vasculitis or Crohn's disease/ulcerative colitis, you could have one of the autoinflammatory diseases, Yao syndrome or other disorders. You may need to see a rheumatologist or geneticist, who specializes in autoinflammatory diseases/periodic fever syndromes for further evaluation and possible periodic fever gene panel testing.

 

To schedule an appointment:

Center of Autoinflammatory Diseases
Stony Brook Medicine
631-444-0580