DiGiovanna J J, Helfgott R K, Gerber L H, Peck G L
N Engl J Med. 1986 Nov 6;315(19):1177-82. doi: 10.1056/NEJM198611063151901.
Isotretinoin, a synthetic retinoid that has been prescribed for over 500,000 patients with cystic acne, has been associated with both spinal hyperostosis and a disorder similar to diffuse idiopathic skeletal hyperostosis. We describe a syndrome of tendon and ligament calcification, primarily in extraspinal locations, that we have observed after long-term therapy for psoriasis and disorders of keratinization with etretinate, another synthetic retinoid. Of 38 patients who had received etretinate (average dose, 0.8 mg per kilogram of body weight per day; average duration, 60 months), 32 (84 percent) had radiographic evidence of extraspinal tendon and ligament calcification. The most common sites of involvement were the ankles (29 patients [76 percent]), pelvis (20 patients [53 percent]), and knees (16 patients [42 percent]); spine involvement was uncommon in this group of etretinate-treated patients. Involvement tended to be bilateral and multifocal. Fifteen (47 percent) of the 32 affected patients had no bone or joint symptoms at the sites of radiographic abnormality. Thus, tendon and ligament calcification can occur without vertebral involvement as well as in association with it (for example, as part of the spectrum of diffuse idiopathic skeletal hyperostosis). We have identified extraspinal tendon and ligament calcification as a toxic effect that is commonly associated with long-term etretinate therapy.
异维A酸是一种已被用于超过50万名囊性痤疮患者的合成维甲酸，它与脊柱骨质增生以及一种类似于弥漫性特发性骨肥厚的病症有关。我们描述了一种主要发生在脊柱外部位的肌腱和韧带钙化综合征，这是我们在用另一种合成维甲酸依曲替酯对银屑病和角化异常疾病进行长期治疗后观察到的。在38名接受依曲替酯治疗的患者中（平均剂量，每天每千克体重0.8毫克；平均疗程，60个月），32名（84%）有脊柱外肌腱和韧带钙化的影像学证据。最常受累的部位是脚踝（29名患者[76%]）、骨盆（20名患者[53%]）和膝盖（16名患者[42%]）；在这组接受依曲替酯治疗的患者中，脊柱受累并不常见。受累往往是双侧和多灶性的。在32名受影响的患者中，有15名（47%）在影像学异常部位没有骨骼或关节症状。因此，肌腱和韧带钙化可在无椎体受累的情况下发生，也可与之相关联（例如，作为弥漫性特发性骨肥厚谱系的一部分）。我们已确定脊柱外肌腱和韧带钙化是一种通常与依曲替酯长期治疗相关的毒性作用。
