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Acute Achilles tendonitis following oral isotretinoin therapy for acne vulgaris - Before Using |
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The second pregnancy test must be done in a lab specified by your doctor. The program also requires females to choose and agree to use two forms of effective birth control at the same time. This precaution goes along with the third requirement. That is, you must agree not to become pregnant while using isotretinoin and for one month before or after treatment. At least one of the birth control methods must be a primary form of birth control.
Examples of these forms are tubal ligation having your tubes tied , an IUD, and hormonal birth control. Another approach is for your partner to have a vasectomy. The only exceptions to this requirement are if you have chosen not to have intercourse with a male abstinence or have had a hysterectomy surgery to remove your uterus. As you can see, there are many risks linked with isotretinoin use.
If you have more questions about these side effects, talk with your doctor. Questions you may ask include:. Your doctor can help you decide if isotretinoin is the right drug for you. They can also help you manage any side effects you have. Isotretinoin belongs to a class of drugs called retinoids. Less oil on your skin gives the acne-causing bacteria less to feed on. With fewer clogged pores, bacteria have fewer places to grow. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.
Accutane was the brand name of a drug for severe acne treatment called isotretinoin. Understanding the risks and knowing the signs of common STDs is crucial for men who are sexually active.
Learn how to spot the main symptoms. While some types of acne scarring are best treated by a dermatologist, others may benefit from over-the-counter topical products.
Ice therapy is routinely used for injuries. But can ice facials help reduce puffy eyes and acne? Learn more about its purported benefits and how to…. Nodules, pustules, whiteheads, and more. Here's what you need to care for it all. Differin Gel uses retinoid to clear up acne and scarring. Here's everything you need to know about the over-the-counter medication. Dairy, chocolate, gluten, and fried foods all get a bad rap for causing acne in adults and teens, but are the claims valid?
This article breaks down 5…. Teenagers tend to experience breakouts and acne due to hormonal changes. There are treatments and skin care habits that can help. What can you do about acne scars? While the AAD suggest things like surgery and laser resurfacing, you might also find relief through less invasive….
While it may be tempting to pop your own pimple, experts recommend that you resist the urge. How Well Do You Sleep? Skin Care. More common side effects Serious side effects Pregnancy warning Takeaway Introduction Accutane is a brand-name version of the drug isotretinoin.
Bone marrow edema consistent with sacroiliitis was observed in It may be an overdiagnosis of sacroiliitis, for this reason, this results should be interpreted with caution. Our patients were symptomatic after using isotretinoin which suggest the hypothesis of drug related sacroiliitis, in addition, MRI follow up to confirm resolution is recommended.
Taheri et al. The authors reported that Of the patients with back pain, Sacroiliitis was determined only in 5 patients [ 10 ]. This study have more patients but no control group. In addition, they assessed only the incidence of low back pain and sacroiliitis but not arthralgia, myalgia, tendinopathy or enthesopathy. Similarly to our study, inflammatory back pain without sacroiliitis was found in the majority of the patients.
It can be claimed that the drug may cause inflammatory back pain without sacroiliitis in healthy subjects. However in our study, numbers of the patients with mechanical back pain were more higher than inflammatory back pain. We showed that mechanical low back pain is a common complication in patients receiving isotretinoin. We recommend that young patients with back pain be questioned about their drug usage, and clinicians need to be aware about this complaint may result from isotretinoin.
In healthy control group, only a few of the volunteers had musculoskeletal pain symptoms such as myalgia, arhtralgia and back pain. None of them had sacroiliitis or tendinopathy. The statistically significant high prevalence of musculoskeletal findings in drug users in the same age group was considered as an important indicator that current symptoms were significantly drug dependent.
This study has some limitations. There is a limited number of patients in total, so the results of the study should be interpreted carefully. Another limitation was that the MRI images of the patients with sacroiliitis were not scored. Furthermore, MRI follow up may be recommended for sacroiliitis positive patients to confirm resolution after drug cessation.
Enthesitis was not evaluated and scored by an imaging method such as ultrasonography or MRI in our study. The diagnosis of enthesitis was depended on solely clinical evaluation.
Further randomized controlled studies are needed with wider patient groups in order to elucidate the musculoskeletal side effects of the isotretinoin. Low back pain is a very common side effect of isotretinoin and it is dose-related. Although sacroiliitis is a rare complication of isotretinoin, inflammatory back pain without sacroiliitis can be seen frequently. The patients suffering from back pain should be asked for drug usage. Considering that musculoskeletal complaints are mostly temporary, they can be often overlooked by clinicians.
For this reason, we recommend the clinicians to perform a more careful and close follow-up in order to carry out the most proper approach to these patients. The prevalence of sacroiliitis in patients with acne vulgaris using isotretinoin. Cutan Ocul Toxicol. Article Google Scholar. Isotretinoin-induced spondyloarthropathy-related symptoms: a prospective study. J Rheumatol. Clin Dermatol. PubMed Article Google Scholar. Ganceviciene R, Zouboulis CC.
Isotretinoin: state of the art treatment for acne vulgaris. J Dtsch Dermatol Ges. Kaplan G, Haettich B. Rheumatological symptoms due to retinoids. Baillieres Clin Rheumatol. Acute hip monoarthritis in a patient treated with isotretinoin. J Clin Rheumatol. Nesher G, Zuckner J. Rheumatological complications of vitamin a and retinoids. Semin Arthritis Rheum. Hughes RA. Arthritis precipitated by isotretinoin treatment for acne vulgaris. Isotretinoin induced achilles tendinopathy: histopathological and biomechanical evaluation on rats.
Acta Orthop Traumatol Turc. Incidence of low back pain and sacroiliitis in military families with acne vulgaris under isotretinoin therapy. Am J Clin Exp Immunol. Isotretinoin-induced bilateral sacroiliitis. Inflammatory back pain in patients treated with isotretinoin. Bilateral sacroiliitis confirmed with magnetic resonance imaging during isotretinoin treatment: assessment of 11 patients and a review of the literature.
Acta Dermatovenereol Croat. Google Scholar. Semira FS. Isotretinoin-induced acute severe myopathy involving pelvic girdle muscles: a case report. Isotretinoin-induced skeletal hyperostosis. Graf Whittle SpringerPlus.
Sacroiliitis and polyneuropathy during isotretrinoin treatment. Clin Exp Dermatol. Isotretinoin-induced arthritis mimicking both rheumatoid arthritis and axial spondiloarthritis. Int J Rheum Dis. Sacroiliitis and severe disability due to isotretinoin therapy. Rheumatol Int. Zhao S, Goodson NJ. Diffuse idiopathic skeletal hyperostosis and isotretinoin in cystic acne. BMJ Case Rep. A patient with chronic sacroiliitis undiagnosed for three years after isotretinoin use.
BMC Musculoskelet Disord. Mease PJ. Arthritis Care Res Hoboken. Koppikar S, Eder L. The management of enthesitis in clinical practice. Curr Opin Rheumatol. Ultrasonographic and clinical assessment of peripheral enthesitis in patients with psoriatic arthritis, psoriasis, and fibromyalgia syndrome - the ULISSE study.
Assessment of enthesis in patients with psoriatic arthritis and fibromyalgia using clinical examination and ultrasound. Clin Exp Rheumatol. PubMed Google Scholar. The assessment of SpondyloArthritis international society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. Imaging of Sacroiliitis. Clin Rheumatol. Imaging of the sacroiliac joint involvement in seronegative spondylarthropathies. Imaging of the Seronegative Spondyloarthropathies.
Curr Rheumatol Rep. Behav Res Methods. Safety and side effects of the acne drug, oral isotretinoin. Expert Opin Drug Saf. Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi-center study. Can isotretinoin induce sacroiliitis: three cases.
Turk J Rheumatol. Sacroiliitis secondary to isotretinoin. Isotretinoin is used to treat severe, disfiguring nodular acne. It should be used only after other acne medicines or antibiotics have been tried and have failed to help the acne.
Isotretinoin may also be used to treat other skin diseases as determined by your doctor. Isotretinoin must not be used to treat women who are able to bear children unless other forms of treatment have been tried first and have failed. Isotretinoin must not be taken during pregnancy because it causes birth defects in humans. If you are able to bear children, it is very important that you read, understand, and follow the pregnancy warnings for isotretinoin. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do.
This is a decision you and your doctor will make. For this medicine, the following should be considered:. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines.
Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Appropriate studies have not been performed on the relationship of age to the effects of isotretinoin in children younger than 12 years of age. Safety and efficacy have not been established. This medicine should be used with caution in teenagers, especially those with bone problems or diseases.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of isotretinoin in the elderly. However, elderly patients are more likely to have serious unwanted effects, which may require caution in patients receiving isotretinoin. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding.
Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below.
The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:. Isotretinoin comes with a patient information form and Medication Guide.
It is very important that you read and understand this information. Be sure to carefully follow these instructions and ask your doctor if you have any questions. Be sure to ask your doctor if you have any questions about this program. It is very important that you understand and follow all of the requirements.
You will not get another prescription unless you follow the instructions for the program. Swallow the capsule whole with a full glass 8 ounces of water or other liquid.
Do not crush, break, chew, or suck the capsule. It is very important that you take isotretinoin only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects. It is very important that you not share this medicine with anyone else because of the risk of birth defects and other serious side effects.
Different brands may not work the same way. If you refill your medicine and it looks different, check with your pharmacist. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine.
If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible.
Accutane is a brand-name version of the drug isotretinoin. The brand is no longer available in the United States. However, the generic version of isotretinoin and other brand-name versions, such as Absorica, are still available. Isotretinoin is used to treat a type of severe acne called nodular acne.
Nodular acne causes red, swollen, tender lumps to form in the skin. If untreated, nodular acne can lead to permanent scarring. While isotretinoin can help treat nodular acne, it can also cause many side effects. Some of these effects can be serious, especially if the drug is taken during pregnancy.
These side effects may go away on their own. The more serious side effects of isotretinoin can have long-term or permanent effects. However, apart from increased cholesterol and joint and muscle problems, these side effects are all quite rare. Isotretinoin can increase the levels of fats and cholesterol in your blood.
During your treatment, your doctor may suggest regular blood tests to check your fat and cholesterol levels. This side effect, if you have it, typically goes away when you finish your treatment with isotretinoin. Learn more: What is metabolic syndrome? Tell your doctor if you plan to do hard physical activity during treatment with isotretinoin. Isotretinoin can cause pain in your bones, joints, muscles, and ligaments.
It can also stunt the growth of long bones in teens, which could have permanent effects. If you have any of the following symptoms, call your doctor right away:. If you break a bone, be sure to tell all of the healthcare providers that care for you that you take isotretinoin. If you have muscle weakness, with or without pain, stop taking isotretinoin and call your doctor right away. Muscle weakness can be a sign of serious muscle damage and could be a permanent effect.
Rarely, isotretinoin can cause increased pressure on the brain. This can lead to permanent loss of eyesight and, in rare cases, death. Stop taking isotretinoin and call your doctor right away if you have any of these symptoms:.
Although rare, a rash caused by isotretinoin can be serious. Stop using isotretinoin and call your doctor right away if you have any of the following symptoms:. Isotretinoin can damage your internal organs. These organs include your liver, pancreas, intestines, and esophagus the tube connecting your mouth and stomach.
The damage may not get better even after you stop taking isotretinoin. This side effect is rare. Still, stop taking isotretinoin and call your doctor right away if you have any of the following symptoms:. Isotretinoin can cause serious hearing problems in rare cases.
Stop using isotretinoin and call your doctor right away if your hearing gets worse or if you have ringing in your ears. Any hearing loss may be permanent. Isotretinoin can cause vision problems such as blurry vision, double vision, and tunnel vision. This drug can also reduce your ability to see in the dark. Vision problems may fix themselves after you stop taking the drug or the damage may be permanent. Isotretinoin can cause your eyes to produce more tears than normal.
If you wear contact lenses, you may have trouble wearing them while taking isotretinoin. Like the other vision problems, this problem may go away after your stop treatment or it may be permanent. All of these vision and eye problems are rare. Nevertheless, stop taking isotretinoin and call your doctor right away if you have problems with your vision, an increased amount of tears, or painful or constant eye dryness.
Isotretinoin can cause serious allergic reactions in rare cases. Stop taking isotretinoin and call your doctor if you have a rash, red patches, or bruises on your legs or a fever. If you have any of the following symptoms, stop taking isotretinoin and call or go to the nearest emergency room:. Isotretinoin may cause blood sugar problems, including diabetes. Call your doctor if you have any of the following symptoms:.
Another rare, serious side effect is a decrease in blood cell levels. Low levels of red blood cells can cause problems such as anemia. Low levels of white blood cells raise your risk of infections. Rarely, isotretinoin can cause serious mental health problems. These include depression, psychosis losing touch with realityand suicidal thoughts or actions. Taking isotretinoin during pregnancy carries an extremely high risk of severe birth defects.
This is true if the drug is used in any amount and even for short periods of time. If you become pregnant during treatment with isotretinoin, stop taking the drug right away.
A gynecologist can then give you further evaluation and counseling. Because of the risks it carries for pregnancies, isotretinoin can be prescribed only under a special restricted distribution program called iPLEDGE.
This program is approved by the Food and Drug Administration. Both males and females who take isotretinoin need to discuss this program with their doctor. Doctors who prescribe isotretinoin and pharmacies that dispense isotretinoin must be registered and activated with the iPLEDGE Program. The second pregnancy test must be done in a lab specified by your doctor. The program also requires females to choose and agree to use two forms of effective birth control at the same time.
This precaution goes along with the third requirement. That is, you must agree not to become pregnant while using isotretinoin and for one month before or after treatment. At least one of the birth control methods must be a primary form of birth control. Examples of these forms are tubal ligation having your tubes tiedan IUD, and hormonal birth control. Another approach is for your partner to have a vasectomy. The only exceptions to this requirement are if you have chosen not to have intercourse with a male abstinence or have had a hysterectomy surgery to remove your uterus.
As you can see, there are many risks linked with isotretinoin use. If you have more questions about these side effects, talk with your doctor. Questions you may ask include:. Your doctor can help you decide if isotretinoin is the right drug for you. They can also help you manage any side effects you have. Isotretinoin belongs to a class of drugs called retinoids. Less oil on your skin gives the acne-causing bacteria less to feed on. With fewer clogged pores, bacteria have fewer places to grow.
Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Accutane was the brand name of a drug for severe acne treatment called isotretinoin. Understanding the risks and knowing the signs of common STDs is crucial for men who are sexually active. Learn how to spot the main symptoms. While some types of acne scarring are best treated by a dermatologist, others may benefit from over-the-counter topical products.
Ice therapy is routinely used for injuries. But can ice facials help reduce puffy eyes and acne? Learn more about its purported benefits and how to…. Nodules, pustules, whiteheads, and more. Here's what you need to care for it all. Differin Gel uses retinoid to clear up acne and scarring. Here's everything you need to know about the over-the-counter medication. Dairy, chocolate, gluten, and fried foods all get a bad rap for causing acne in adults and teens, but are the claims valid?
This article breaks down 5…. Teenagers tend to experience breakouts and acne due to hormonal changes. There are treatments and skin care habits that can help.
What can you do about acne scars? While the AAD suggest things like surgery and laser resurfacing, you might also find relief through less invasive…. While it may be tempting to pop your own pimple, experts recommend that you resist the urge. How Well Do You Sleep? Skin Care. More common side effects Serious side effects Pregnancy warning Takeaway Introduction Accutane is a brand-name version of the drug isotretinoin.
The present study detected histopathological and biomechanical negative effect of isotretinoin on Achilles tendon. Therefore, isotretinoin should be. It may also cause several musculoskeletal side effects such as arthralgia, myalgia, back pain, spondyloarthropathy-related symptoms and. scaling, redness, burning. fluoroquinolone antibiotics, glucocorticoids (long-term regimens), and isotretinoin. cause of tendon degeneration following drug exposure cannot. We report three cases of acute Achilles tendonitis following administration of isotretinoin for acne vulgaris. In this rarely documented side-effect. It was queried that whether myalgia, arthralgia and low back pain occurred after starting isotretinoin treatment.Metrics details. Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit. Isotretinoin is an effective treatment option for severe acne.
The aim of this study was to evaluate musculoskeletal side effects of systemic isotretinoin treatment. Ninety-four patients with acne vulgaris and sex- and age-matched controls were enrolled in this study. Only the patients who had musculoskeletal symptoms were evaluated in this study. All participants were firstly assessed by a dermatologist. The patients were asked whether they had any musculoskeletal symptoms after isotretinoin treatment, if so, the feature and duration of the symptoms were recorded.
The dosage of the drug, treatment duration, incidence of arthralgia, myalgia, low back pain, sacroiliitis and tendinopathy and laboratory test results were noted. The severity of pain was assessed by visual analog scale VAS. Of the 94 patients, 71 were female and 23 were male. Bone marrow edema consistent with sacroiliitis was detected by sacroiliac MRI in 11 patients with inflammatory back pain. Low back pain is one of the very common complications of isotretinoin.
It can be mostly mechanical or inflammatory. Isotretinoin-induced low back pain is dose-related, and inflammatory back pain without sacroiliitis is also frequent. The clinicians should be aware of the back pain may be a reflective of sacroiliitis during isotretinoin usage. Peer Review reports. Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit with multifactorial etiology [ 1 ]. Isotretinoin is an effective treatment option for severe acne vulgaris.
Isotretinoin has a wide spectrum of side effects, including multiorgan systems such as reproductive, mucocutaneous, ocular, neurological, musculoskeletal and hepatic systems. It may also cause several musculoskeletal side effects such as arthralgia, myalgia, back pain, spondyloarthropathy-related symptoms and sacroiliitis [ 1 , 2 , 3 ].
Other uncommon musculoskeletal disorders related with isotretinoin are hyperostosis, extraspinal calcifications, enthesitis, arthritis, costochondritis, osteoporosis, growth retardation, premature epiphyseal closure in children and as well as gout [ 3 , 6 , 7 , 8 ]. In the literature, there are only a few original studies investigating the musculoskeletal side effects of isotretinoin [ 1 , 2 , 9 , 10 ]. Furthermore, there are many case reports or case series indicating the musculoskeletal side effects of isotretinoin [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].
The majority of the recently performed studies are the case studies regarding with isotretinoin-induced sacroiliitis [ 11 , 13 , 16 , 18 , 20 ]. To the best our knowledge, there is no controlled study investigating the presence of isotretinoin-related musculoskeletal side effects with a wide spectrum such as arthralgia, myalgia, low back pain, sacroiliitis, tendinopathy and enthesopathy.
In previous studies, the incidence of sacroiliitis and back pain were the most detected parameters [ 1 , 2 , 10 ]. The primary aim of this study was to evaluate and emphasize the musculoskeletal side effects of systemic isotretinoin treatment in patients with acne vulgaris and to compare them with healthy controls. The second aim was to elucidate clinicians regarding with isotretinoin-induced musculoskeletal symptoms.
A total of 94 patients with moderate to severe acne vulgaris treated with systemic isotretinoin and sex- and age-matched controls who were admitted to Ankara Training and Research Hospital, Department of Dermatology, between September and April were enrolled in this cross-sectional study.
The local ethics committee approved the study. All participants were informed about the study and their written consent form was obtained. Isotretinoin group included the patients under isotretinoin treatment for acne vulgaris, but had no history of rheumatologic syndromes.
The control group was selected from among health professionals who had received a routine medical checkup in the hospital. Exclusion criteria for this study were the presence of any chronic rheumatological, dermatological diseases or any patients with a history of mechanical back pain, inflammatory back pain, sacroiliitis, enthesitis, before starting isotretinoin, history suggestive of spondyloarthropathies reactive arthritis, ankylosing spondylitis, inflammatory bowel disease, and psoriasis , or systemic autoimmune disorders.
Also, the patients with depression or similar psychiatric diseases, had renal and liver function disorders, those who were pregnant or using any systemic drugs for other diseases, were not included. All participants were firstly evaluated by a dermatologist and questioned carefully about the musculoskeletal symptoms.
Only the patients who had musculoskeletal symptoms such as myalgia, arthralgia, back pain were determined and enrolled in the study. They were referred to the physical medicine and rehabilitation department and examined by a specialist. Sociodemographic information, including age, sex, history of drug use dose and duration , history of chronic diseases were recorded. A detailed anamnesis was obtained and a careful dermatological and physical examination was performed by both of the specialists.
It was queried that whether myalgia, arthralgia and low back pain occurred after starting isotretinoin treatment. Data were recorded on a standardized pre-prepared evaluation form. The pain severity of the participants was evaluated by visual analog scale VAS based on a chart numbered from 0 no symptom to 10 maximum severity. According to GAGS, the body was divided into six regions -forehead, nose, each cheek, chin and back.
In each region, each type of lesion is given a number: zero for no lesion, one for comedones, two for papules, three for pustules and four for nodules. It was investigated that whether there was a enthesitis by a detailed clinical examination.
The following entheses were examined for tenderness and swelling bilaterally: common extensor tendon insertion on the lateral epicondyle of the humerus, quadriceps tendon, patellar tendon, tibial tuberosity, knee medial collateral ligament, Achilles tendon, and plantar fascia insertion on the calcaneus [ 23 ]. If there was a swelling and erythema, it was considered as inflammatory enthesitis. The absence of swelling or erythema was considered to be mechanical enthesitis.
The ASAS criteria consist of commencement under the age of 40, insidious onset, relief with exercise, no relief with rest and nocturnal pain improving with rising up from bed.
These 4 items are essential in diagnosing inflammatory low back pain. The various imaging modalities, including conventional radiography, computed tomography CT , magnetic resonance imaging MRI and bone scintigraphy are used for investigation of inflammatory changes at the sacroiliac joints. In early and acute stages of sacroiliitis the diagnosis can be difficult because conventional radiographs may be normal.
Inflammatory back pain is not a specific indicator of sacroiliitis. Therefore, there is need for valuable imaging methods. Scintigraphy lacks specificity. CT is a very good method for visualization of established bony destruction or ossification. MRI can identify both inflammation and structural changes, localise different degrees of inflammation and bone marrow edema, and differentiate a possible septic sacroiliitis. MRI is the most sensitive and specific modality for sacroiliitis by directly imaging changes in the synovium, articular cartilage, and subchondral bone [ 26 , 27 , 28 ].
In our study, the patients meeting ASAS criteria for inflammatory back pain were evaluated in detail and requested both sacroiliac radiography and sacroiliac MRI.
Sacroiliac MRI was performed on 1. At least 12 slices of coronal oblique T1-weighted turbo spin-echo and short tau inversion recovery STIR sequences of the sacroiliac joints were acquired.
This images were interpreted by the same reader who had received standardized training and were blinded with regard to the study groups.
In addition, laboratory blood tests including rheumatoid factor RF , erythrocyte sedimentation rate ESR and c-reactive protein CRP values were requested. Anti-nuclear antibody ANA was ordered to rule out other connective tissue diseases. Data were analyzed using SPSS software version The normality of the data was tested by Kolmogorov-Smirnov test.
For the comparison of the paired groups, the independent samples t-test normal distribution and the Mann-Whitney U test non-normal distribution were used for the quantitative data.
Chi-squared test was used to evaluate whether there was a difference in terms of musculoskeletal symptoms between the study groups. This case-control study included 94 71 women, 23 men patients with acne vulgaris receiving isotretinoin and 74 women, 26 men age- and sex-matched controls. The age and sex distributions of the study and control groups are presented in Table 1.
All of the tendinopathies were mechanical feature, swelling or erythema was not observed. The flow chart of the participants was presented in Fig. The median duration of treatment was 3 min. There was a total of 66 patients The clinical characteristics of both isotretinoin group and healthy controls can be seen in Table 2. The median duration of treatment was 3 IQR: 3, min. The comparison of the patients who had musculoskeletal symptoms or not in isotretinoin group regarding as total cumulative dose of drug were given in Table 3.
The results of linear regression analysis between the age, sex, duration of treatment and cumulative dose of drug with musculoskeletal side effects were shown in Table 4. The sacroiliac radiography was normal in all of the patients with inflammatory back pain. In sacroiliac MRI, sacroiliitis was observed in 11 Semicoronal short tau inversion recovery STIR images show hyperintense lesions arrows consistent with bone marrow edema in bilateral sacroiliac joints.
Semicoronal T1-weighted spin-echo image shows signal loss arrows in sacroiliac joints consistent with sacroiliitis. The patients who developed rheumatologic symptoms during isotretinoin usage were called to follow-ups by monthly.
They were evaluated by a specialist and physical examination was performed at each time they came to control. VAS scores of the patients were also assessed at each follow-up. In addition, routine biochemical blood tests were acquired from all of the patients in isotretinoin group.
The patients who developed musculoskeletal symptoms such as mechanical back pain, arthralgia, myalgia or tendinopathy, except for sacroiliitis were initiated a nonsteroidal antiinflammatory drugs NSAID and continued a lower dose of isotretinoin. In patients who were diagnosed as sacroiliitis, the drug was discontinued immediately and a NSAID was prescribed.
We observed that the complaints of these patients were resolved within a month after cessation of the drug and VAS scores were also decreased dramatically. The symptoms were mostly disappeared by the third month.
All the patients with sacroiliitis were completely symptom free at the sixth month of the discontinuation of the drug. Isotretinoin, or cis retinoic acid, is a vitamin A derivative used for severe recalcitrant acne since Although isotretinoin is a very effective drug, it may have many side effects. It is essential that the clinician should be careful about the various side effects of the drug [ 30 ]. In this study, we focused on the musculoskeletal side effects of isotretinoin.
Ninety-four patients treated with isotretinoin suffering from musculoskeletal pain were included. The patients were then examined in detail.
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