Rheumatologic complications of vitamin a and retinoids

British Association of Dermatologists guidelines on the efficacy and use of acitretin in dermatology

“…Arthralgia and myalgia represent the most frequent rheumatological sequelae, occurring in up to 25% of patients. 111 Two previous small studies indicated a possible increased risk of osteoporosis in subjects receiving etretinate and this is a feature of the hypervitaminosis A syndrome; 112,113 however, a further study has refuted this risk 114 and in a prospective study of 30 patients treated for 3AE6 years with acitretin, osteoporosis was not detected on DEXA scans.…”

Regulation of matrix metalloproteinase gene expression by a retinoid X receptor–specific ligand

“…In humans, the MMP family currently encompasses 23 unique members, which degrade all constituents of the extracellular matrix (ECM) (5). The MMPs can be subdivided into 6 main classes (1,4,5), consisting of the collagenases (MMPs 1, 8, and 13), the gelatinases (MMPs 2 and 9), the stromelysins (MMPs 3, 10, and 11), the matrilysins (MMPs 7 and 26), the membrane-type MMPs (MMPs 14,15,16,17,24,and 25), and a diverse subgroup.The collagenase subgroup is unique in its ability to cleave fibrillar collagens, and their enzymatic activity represents a rate-limiting step in the degradation of collagen-containing tissues. MMP-1 is expressed by a range of cell types, including chondrocytes and fibroblasts, and is most effective against type III collagen.…”

“…In humans, the MMP family currently encompasses 23 unique members, which degrade all constituents of the extracellular matrix (ECM) (5). The MMPs can be subdivided into 6 main classes (1,4,5), consisting of the collagenases (MMPs 1, 8, and 13), the gelatinases (MMPs 2 and 9), the stromelysins (MMPs 3, 10, and 11), the matrilysins (MMPs 7 and 26), the membrane-type MMPs (MMPs 14,15,16,17,24,and 25), and a diverse subgroup.…”

“…The retinoids are ligands for a family of nuclear hormone receptors (NHRs), the retinoic acid receptors (RARs; ␣, ␤, and ␥), and are thought to inhibit MMP production primarily by affecting the levels of AP-1 proteins (9). Although they are effective inhibitors of MMP expression (10)(11)(12)(13), the retinoids have pleiotropic effects, which lead to significant clinical toxicities (14,15). Some retinoid compounds called panagonists have binding affinity for another group of NHRs, the retinoid X receptors (RXRs; ␣, ␤, and ␥).…”

Rheumatic manifestations of current pharmacopeia

“…In 1996, Nesher et al [1] extensively reviewed the rheumatologic complications of vitamin A and the retinoids, a class of drug used largely for various dermatologic conditions and malignancies. Their long-term use has been associated with bone abnormalities and symptoms resembling seronegative spondyloarthropathies and Diffuse Idiopathic Skeletal Hyperostosis (DISH).…”