Sacroiliitis during isotretinoin treatment: causal association or coincidence?

Aydoğ, Ece; Öztürk, Gülcan; Cömert, Asuman; Taşdelen, Neslihan; Akın, Osman; Külcü, Duygu Geler

doi:10.14744/nci.2018.93798

Cited by 10 publications

(18 citation statements)

References 12 publications

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“…Ekşioğlu et al, who presented a case of isotretinoin-associated polyneuropathy and sacroiliitis, mentioned that HLA-B27-positive individuals might develop sacroiliitis [2]. However, in the literature, most cases of ISOinduced sacroiliitis were usually HLA-27 negative [12][13][14][15]. Similarly, in our patient, chronic sacroiliitis was accompanied by HLA-B27 negativity.…”

Section: Discussionsupporting

confidence: 54%

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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Section: Discussionsupporting

confidence: 54%

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

Mülkoğlu

Nacır

2020

BMC Musculoskelet Disord

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“…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 …”

Section: Discussionmentioning

confidence: 68%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Karadağ

Sönmez

Tanatar

et al. 2019

Pediatric Dermatology

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Isotretinoin is the mainstay treatment in severe acne; however, its musculoskeletal adverse effects such as lower‐back pain can be disabling. Herein, we present four cases of isotretinoin‐induced sacroiliitis with variable severity. We also present a review of the literature of isotretinoin‐induced sacroiliitis. All our cases were male and human leukocyte antigen (HLA)‐B27 negative. Sacroiliitis was detected a median of 55 (10‐120) days after isotretinoin initiation. Two patients were responsive to baseline sulfasalazine and indomethacin treatment, while the other two patients required more intensive treatments: adalimumab in one and methotrexate in the other. We also identified 15 articles describing 33 patients (17 of whom were female) with isotretinoin‐induced sacroiliitis. Most of them were responsive to low‐to‐medium doses of systemic steroids or non‐steroidal anti‐inflammatory drugs (NSAIDs). Our patients illustrate that severity of isotretinoin‐induced sacroiliitis varies from patient to patient.

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“…However, they can lead to ankylosing and potentially permanent disability. For example, in one of the studies, indicating relation between sacroilitis and isotretinoin usage, 1 per 5 patients presented chronic sacroilitis in 1 year follow-up, despite discontinuation of isotretinoin treatment [21]. Lower back pain was reported with significant 82,7% frequency.…”

Section: Did You Experience Lower Back Pain During Treatment?mentioning

confidence: 98%

“…It may also increase MMP-2 activity, which is present at high levels in arthritic joints [17]. Isotretinoin-induced arthritis and sacroilitis are typically selflimiting and resolve within a few weeks or months after discontinuation of isotretinoin treatment and NSAIDs use [17,21]. However, they can lead to ankylosing and potentially permanent disability.…”

Section: Did You Experience Lower Back Pain During Treatment?mentioning

confidence: 99%

Impact of oral isotretinoin therapy on musculoskeletal system and physical activity in patients with acne

Drozd¹,

Czarnota²,

Dobrzyński³

et al. 2020

J Educ Health Sport

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Introduction and purpose: Isotretinoin, the vitamin A derivative, has been commonly used in treatment of acne vulgaris for years. Despite its unquestionable efficacy, chronic oral isotretinoin treatment leads to multiple side effects. The aim of study is analysis of musculoskeletal symptoms prevalence during oral isotretinoin treatment and their impact on physical activity.Material and methods: The study was conducted using the original survey questionnaire shared online among members of Polish group of patients treated for acne. Total of 196 responses were analyzed and compared with up-to-date literature related to the topic.Results: 86,7% of respondents reported at least one of the musculoskeletal symptoms. The most common were back pain (82,7%), fatigue and lethargy (70,4%), myalgia (55,1%) and arthalgia (32,1%). In 97,6% cases adverse effects were developed within the first 6 months of treatment. In 64,2% they persisted during the whole therapy, sometimes even beyond. Due to musculoskeletal side effects, in 2,4% cases dose reduction was necessary, 1,8% of respondents had to stop treatment and 48% had to limit or stop physical activity. 71,4% of repondents reported that lower back pain occurred or escalated during isotretinoin treatment.Conclusions: Prevalence of reported musculoskeletal symptoms is very high and totals 86,7%. They result in prolonged limiting or stopping of physical activity in almost 50% of people. Although musculoskeletal symptoms are typically benign, possibility of severe disorders and potential permanent effects must be taken into consideration.

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Sacroiliitis during isotretinoin treatment: causal association or coincidence?

Cited by 10 publications

References 12 publications

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

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

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

Impact of oral isotretinoin therapy on musculoskeletal system and physical activity in patients with acne

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