Background/Purpose: Adverse events of medications have been reported to account for 5% of hospital admissions in the US, and as many as 10% in the elderly. Strategies for vigilance for adverse events are actively promoted by physicians, pharmacies, pharmacists, and pharmaceutical companies.  Some adverse events are relatively obvious, such as a severe rash or severely abnormal laboratory test.  However, many adverse events are common symptoms, such as fatigue, headache, anxiety, which might not be recognized as adverse events until present over long periods, particularly in elderly individuals who have one or more chronic conditions. An MDHAQ (multidimensional health assessment questionnaire) has been found to be useful in all rheumatic diseases studied¹. The MDHAQ includes a 60-symptom checklist that can be used to monitor adverse events. We analyzed a hypothesis that a 60-symptom checklist to monitor early medication outcomes (MDHAQ/MEMO60) could be useful to recognize adverse events in patients who are treated with RA medications.

Methods: At one academic rheumatology site, all patients complete an MDHAQ at all visits prior to seeing the rheumatologist to add to quality of care. The 2-page MDHAQ includes 0-10 scales for physical function + pain + patient global VAS, compiled into a continuous 0-30 RAPID3 (routine assessment of patient index data), to depict clinical status.  The MDHAQ also includes a 60-symptom checklist to recognize comorbidities, review of systems, and potential adverse events associated with medications.  Completed paper versions of MDHAQ from routine care are scanned into an Epic electronic medical record (EMR) and copied into a data repository for retrospective analyses.  A list of common adverse events of many specific DMARDs (disease-modifying antirheumatic drugs) and biological agents used to treat rheumatoid arthritis (RA) was compiled from websites of the FDA, pharmaceutical companies, and Up-to-date.®  A retrospective review of scanned MDHAQs at the first visit were included in a database of ICD-code-identified RA patients.  This database was analyzed to recognize symptoms self-reported on MDHAQ/MEMO60 which were listed as common adverse events for RA medications , using simple descriptive statistics.

Results: Among 711 RA patients identified at their first visit, 84% were females, mean age was 58.5 (15.2) years, 40% were White, 30% Black, 23% Latino, 7% “other.”   Among commonly-listed specific adverse events associated with RA medications, more than 30% of 711 patients reported headache and/or  unusual fatigue (Table); 20-30% anxiety-feeling nervous; 10-20% cough, dizziness, hair loss, nausea, skin rash or hives, stomach pain or cramps, eye problems, and/or weight loss; and 5-10%  diarrhea, fever, and/or mouth sores (Table).

Conclusion: MHDAQ/MEMO60 may prove valuable to detect adverse events of high-risk medications.  A program involving completion of a weekly remote electronic MDHAQ at home for 12 weeks after initiation of a new medication may be a cost-effective approach for early recognition of efficacy and detection of adverse events.

Reference: 1. Castrejon I. Bull Hosp Jt Dis (2013). 2017;75(2):93-100.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/can-an-mdhaq-multidimensional-health-assessment-questionnaire-60-symptom-checklist-to-monitor-early-medication-outcomes-mdhaq-memo60-detect-adverse-events-of-high-risk-medications/