Isotretinoin‐induced arthritis mimicking both rheumatoid arthritis and axial spondyloarthritis

Abstract

Isotretinoin is used for the treatment of various acne lesions that are resistant to other treatments. The most frequent rheumatologic side effect of isotretinoin is transient muscle and/or joint pains. Here, we report a case with bilateral wrist and metacarpophalangeal joint arthritis and unilateral sacroiliitis associated with isotretinoin usage to attract attention, particularly from physiatrists, rheumatologists and dermatologists, to this rare adverse effect of isotretinoin.

Isotretinoin‐induced sacroiliitis: Case series of four patients and a systematic review of the literature

“…At the last visit, laboratory tests and clinical features were completely normal in all patients. Similarly, in the literature, two patients required adalimumab, one needed methotrexate, and three patients also received sulfasalazine along with steroid treatment and NSAIDs …”

“…An association between isotretinoin therapy and sacroiliitis had been previously described. During our literature search, 15 articles describing 33 patients with isotretinoin‐induced sacroiliitis were identified . Among them, 16 were male, and five patients were HLA‐B27 positive.…”

Sacroiliitis during isotretinoin treatment: causal association or coincidence?

“…Musculoskeletal side effects include arthralgia, rhabdomyolysis, hyperostosis, osteolysis, ligamentous calcifications, and vasculitis [6]. In recent literature, sacroiliitis has been described as an uncommon side effect in case reports [6-12].…”

Perinuclear antineutrophil cytoplasmic antibody–positive vasculitis, oligoarthritis, tendinitis, and myositis associated with isotretinoin in a 15‐year‐old boy: Case report and review of literature

“…Isotretinoin is a synthetic derivative of vitamin A (retinoic acid) . Its pharmacokinetic properties are not well known, but the absolute bioavailability is estimated to be 25%, although because of its high lipophilicity, intake with a high‐fat meal will more than double the exposure.…”

“…The patient developed arthritis of the left ankle and elbow and both wrists. Multiple case reports have been published demonstrating an association between use of isotretinoin and arthritis, among others of the wrists, metacarpophalangeal joints, and knees . In some patients, a dose‐dependent relationship and recurrence of symptoms upon rechallenge have been described .…”