Department of Rheumatology, Al Hada Armed Forces Hospital, Taif, 21944, Kingdom of Saudi Arabia.
Department of Rheumatology and Physical Medicine, Benha University, Benha, Egypt.
Clin Rheumatol. 2020 Jun;39(6):1829-1838. doi: 10.1007/s10067-020-04957-0. Epub 2020 Feb 7.
Oral isotretinoin is commonly prescribed for acne vulgaris. Several case reports and observational studies have reported serious musculoskeletal side effects; however, the incidence, imaging findings, and longitudinal follow-up data are limited for patients who develop inflammatory back pain (IBP).
To assess the incidence of isotretinoin-triggered axial spondyloarthropathy (SpA) in acne vulgaris patients based on clinical features and MRI findings and to examine clinical and radiological outcomes following drug withdrawal.
Five hundred thirteen acne patients receiving isotretinoin were screened for IBP; IBP patients were assessed for CRP, plain radiographs, and MRI of the sacroiliac joint. MRI-proven sacroiliitis was scored semi-quantitatively. Patients were followed longitudinally to assess SpA clinical course and longitudinal MRI sacroiliac joints, and CRP levels were reassessed 3 weeks after patients were symptom-free, following isotretinoin discontinuation.
Of the 513 patients, 23.98% developed IBP. MRI-proven sacroiliitis was detected in 42.3% of the symptomatic patients or 10.1% of the cohort. Among MRI-proven sacroiliitis cases, 51.9% fulfilled the Assessment of Spondyloarthritis International Society criteria for axial SpA. Mean CRP level was 32.05 ± 17.23 mg/L at pain onset and 3.4 ± 2.7 mg/L after symptom resolution. MRI findings completely resolved within 9 months (mean 6.27 ± 1.7) after isotretinoin discontinuation. MRI scores positively correlated with baseline CRP levels and global acne grading system score, pain, and the Ankylosing Spondylitis Disease Activity Score.
Isotretinoin-induced axial SpA is a prevalent side effect in acne vulgaris patients. Early detection and follow-up of isotretinoin-induced sacroiliitis can be facilitated by MRI. Cessation of isotretinoin resulted in complete resolution in all affected patients.Key Points• Detection of underdiagnosed isotretinoin side effects which are common but not always correctly diagnosed and managed.• Incidence, diagnosis, and management of these side effects in a real-world setting.• This is the first large prospective longitudinal cohort study to report on axial manifestations in patients treated with isotretinoin as well as the effect of drug cessation upon the clinical, laboratory, and radiological findings.
口服异维 A 酸常用于治疗寻常痤疮。有几项病例报告和观察性研究报道了严重的肌肉骨骼副作用；然而，对于出现炎症性背痛（IBP）的患者，其发病率、影像学表现和纵向随访数据有限。
根据临床特征和 MRI 结果评估寻常痤疮患者中异维 A 酸诱发的轴性脊柱关节炎（SpA）的发生率，并检查停药后的临床和放射学结果。
对 513 名接受异维 A 酸治疗的痤疮患者进行了 IBP 筛查；对 IBP 患者进行了 CRP、平片和骶髂关节 MRI 检查。对 MRI 证实的骶髂关节炎进行半定量评分。对患者进行纵向随访，以评估 SpA 的临床病程和纵向骶髂关节，以及 CRP 水平，在患者停药后 3 周无症状时重新评估。
在 513 名患者中，23.98%出现 IBP。在有症状的患者中，42.3%或队列中 10.1%的患者 MRI 证实存在骶髂关节炎。在 MRI 证实的骶髂关节炎病例中，51.9%符合评估脊柱关节炎国际协会的轴性 SpA 标准。疼痛发作时平均 CRP 水平为 32.05±17.23mg/L，症状缓解后为 3.4±2.7mg/L。MRI 发现完全在异维 A 酸停药后 9 个月内（平均 6.27±1.7）消退。MRI 评分与基线 CRP 水平、全球痤疮分级系统评分、疼痛和强直性脊柱炎疾病活动评分呈正相关。
异维 A 酸诱导的轴性 SpA 是痤疮患者常见的一种普遍的副作用。MRI 可促进对异维 A 酸诱导的骶髂关节炎的早期发现和随访。异维 A 酸停药后，所有受累患者均完全缓解。
发现诊断不足的异维 A 酸副作用，这些副作用很常见，但并非总是得到正确的诊断和管理。
在真实环境中，这些副作用的发生率、诊断和管理。
这是第一项报告异维 A 酸治疗患者的轴性表现以及药物停药对临床、实验室和放射学发现影响的大型前瞻性纵向队列研究。
