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

Karadağ, Şerife Gül; Sönmez, Hafize Emine; Tanatar, Ayşe; Çakan, Mustafa; Ayaz, Nuray Aktay

doi:10.1111/pde.14035

Cited by 8 publications

(12 citation statements)

References 21 publications

(48 reference statements)

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“…5,12 But the majority of such case reports declare that HLA-B27 is found negative. 3,6,7,10,[12][13][14] In our case, the patient had a negative HLA-B27 as well. MRI was performed after 3 weeks of her initial pain and it showed increased signal intensity and bone marrow oedema of the sacroiliac joints.…”

Section: Discussionsupporting

confidence: 52%

“…9 In the literature, there are reports of cases of unilateral or bilateral sacroiliitis after isotretinoin use. [3][4][5][6][7][8]10 The mechanism of the sacroiliitis is not understood clearly. It is thought that isotretinoin shows detergentlike effects and induces changes in lysosomal membrane structures, causing degeneration in synovial cells, induces hypersensitivity reactions on these cells, and causes synovial cells to become sensitive to minor or mild traumas.…”

Section: Discussionmentioning

confidence: 99%

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Isotretinoin Treatment-Induced Sacroiliitis

Gökbel¹,

Gözpinar²,

Dursun³

et al. 2021

Turkiye Klinikleri J Case Rep

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Isotretinoin, a vitamin A derivative, is approved by the Food and Drug Administration as a cure for severe recalcitrant acne vulgaris, and recommended for severe nodular acne and treatment resistant moderate acne. 1 Many adverse effects associated with the isotretinoin use have been reported. Among those, the most common adverse effects include mucocutaneous, musculoskeletal and ophthalmological systems. These adverse effects are temporary and reduce without sequelae following the discontinuation of the drug. 1 Adverse effects in the musculoskeletal system are bone abnormalities and rheumatologic manifestations. 2 Seronegative spondyloarthropathy (SpA) like abnormalities including hyperosteosis, extraspinal calcifications, diffuse idiopathic skeletal hyperosteosis, bilateral and unilateral sacroiliitis, enthesopathy, costochondritis, and arthralgia, arthritis, myalgia, myopathy, vasculitis, and other complications have all been reported. 2 While arthralgia and myalgia are more common in case reports, sacroiliitis has been described as a rare side effect. [3][4][5][6] Herein, we report and describe the case of a 26-year-old female diagnosed with sacroiliitis after 8 weeks of isotretinoin treatment. CASE REPORTA 26-year-old female patient had used isotretinoin 30 mg daily for her facial acne for a period of 2 months, 2 years ago. After 8 weeks of isotretinoin treatment, she experienced inflammatory pain in her lower back and right hip region. Due to this pain, the isotretinoin treatment was ceased. While the lower back pain decreased, her right hip pain was persistent. She did not report any significant trauma and she had no histories of recent genitourinary or gastrointestinal infections. Her written inform consent was provided.Regarding physical examination, the lumbar flexion of the patient was normal and the sacroiliac stress test was positive on the right side. There were no enthesopathy, peripheral arthiritis, ocular findings, cutaneous lesions. The other locomotor and neurologic system findings appeared to be normal.Laboratory analysis showed that blood chemistry and complete blood count were in a normal range, while acute phase reactants including C-reactive protein and erythrocyte sedimentation levels were elevated [10.88 mg/dL (normal range: ≤0.5 mg/dL) and 87 mm/h (normal range: 0-20 mm/h), respectively]. These levels decreased to normal

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Isotretinoin Treatment-Induced Sacroiliitis

Gökbel¹,

Gözpinar²,

Dursun³

et al. 2021

Turkiye Klinikleri J Case Rep

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“…Literatürde 18 farklı olgu bildirimi ve çalışmada toplam 99 izotretinoin ilişkili sakroiliit olgusu bildirilmiştir (5,8,9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Bu hastaların özellikleri Tablo 3'te verilmiştir.…”

Section: Discussionunclassified

Evaluation of the Prevalence of Sacroileitis in Acne Vulgaris Patients Treated with Isotretinoin

Gündoğdu¹,

Yıldızhan²

2021

atfm

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Amaç: İzotretinoin, akne vulgaris tedavisinde oldukça etkili sentetik bir A vitamini türevidir. Son yıllarda literatürde izotretinoin tedavisine bağlı birkaç sakroiliit olgusu ve az sayıda klinik kohort çalışma bildirilmiştir. Bu çalışmanın amacı akne vulgaris hastalarında izotretinoine bağlı sakroiliit prevalansını değerlendirmektir.Gereç ve Yöntem: Dermatoloji polikliniğinde izotretinoin tedavisi başlanan 468 akne vulgaris hastasından tedavi ile ilişkilendirilen bel-sırt ağrıları ve/veya sabah tutukluğu tarifleyen ve romatoloji polikliniğine yönlendirilen 99 hasta çalışmaya dahil edildi ve kayıtları retrospektif olarak incelendi. Enflamatuvar bel ağrısı (İBA), tek romatolog tarafından Uluslararası Spondiloartrit Değerlendirme Derneği (ASAS) kriterleri kullanılarak tespit edildi. ASAS kriterlerini karşılayan hastalar direkt pelvis radyografisi ile ve sakroiliit şüphesi olan hastalar sakroiliak eklem (SİE) manyetik rezonans görüntüleme (MRG) ile değerlendirildi.Bulgular: Hastaların 79'u kadındı ve tüm hastaların yaş ortalaması 19,8±3,6 yıldı. Günlük ortalama izotretinoin dozu 39,1±2,7 mg ve ortalama tedavi süresi 6,2±0,6 aydı. İzotretinoin tedavisi sırasında hastaların %24,2'sinde mekanik bel ağrısı ve %9,1'inde ise İBA saptandı. Cinsiyete göre mekanik bel ağrısı ve İBA sıklığı bakımından istatistiksel açıdan fark saptanmadı (p>0,05). SİE MRG'de sakroiliit sıklığı %4,04 (n=4) olarak belirlendi. Üç hastada tek taraflı, 1 hastada ise bilateral sakroiliit tespit edildi. Sakroiliit saptanan hastaların hepsi kadın hastalardı.Sonuç: Bu çalışmada anormal fizik muayene bulgularına dayalı olarak izotretinoin ilişkili sakroiliit prelavansı vurgulanmıştır. Her ne kadar fizik muayene ve İBA tespiti sakroiliitin saptanılmasında çok duyarlı olmasa da erken tespitinde yol göstericidir. İzotretinoin tedavisi alan akne vulgaris hastaları özellikle bel ağrısı tariflediklerinde sakroiliit gelişimi yönünden değerlendirilmelidir.

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“…The sacroiliac MRI findings were normal for both patients at the ninth month of modified medical therapy. The authors stated that the severity of ISO-induced sacroiliitis varied from one patient to another [16]. Yilmaz Tasdelen et al reported a 23 year-old male patient with bilateral arthritis of wrist and metacarpophalangeal joints when he was on isotretinoin treatment for cystic acne lesions.…”

Section: Discussionmentioning

confidence: 99%

A patient with chronic sacroiliitis undiagnosed for three years after isotretinoin use

Mülkoğlu

Nacır

2020

BMC Musculoskelet Disord

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Background: Isotretinoin (ISO) is a synthetic vitamin A derivative which has been used for treatment-resistant acne vulgaris. Although most musculoskeletal side effects of ISO are common, including myalgia, arthralgia, and back pain, sacroiliitis is one of the uncommon side effects. ISO-induced sacroiliitis usually completely resolves within a few months by the cessation of the drug. Case presentation: In this paper, we present a 26-year-old female patient with chronic sacroiliitis that was probably induced by ISO and not resolved by the discontinuation of the drug. Conclusion: In this patient, sacroiliitis was overlooked for three years. Therefore, ISO usage should be considered in the differential diagnosis of sacroiliitis and low back pain.

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

Cited by 8 publications

References 21 publications

Isotretinoin Treatment-Induced Sacroiliitis

Isotretinoin Treatment-Induced Sacroiliitis

Evaluation of the Prevalence of Sacroileitis in Acne Vulgaris Patients Treated with Isotretinoin

A patient with chronic sacroiliitis undiagnosed for three years after isotretinoin use

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