isotretinoin and Arthritis

We present a patient in whom a combination of perinuclear antineutrophil cytoplasmic antibody-positive vasculitis, oligoarthritis, tendinitis, and myositis was considered to be associated with isotretinoin use. Discontinuation of the drug resulted in complete clinical and biochemical remission (normalization of perinuclear antineutrophil cytoplasmic antibody titer). Although we were unable to prove causality, no other underlying cause for the patient's course was found. We report this occurrence to bring it to the attention of physicians prescribing isotretinoin.

Topics: Acne Vulgaris; Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Antineutrophil Cytoplasmic; Arthritis; Dermatologic Agents; Diagnosis, Differential; Humans; Isotretinoin; Magnetic Resonance Imaging; Male; Myositis; Skin; Tendinopathy; Vasculitis; Withholding Treatment

We describe the case of a 21-year-old woman who developed biopsy proven seronegative oligoarthritis in association with isotretinoin treatment for acne vulgaris. Elevated levels of antinuclear antibody accompanied joint disease and resolution occurred over a 6-month period. Isotretinoin, an orally active derivative of vitamin A, has been associated with reported arthritis, arthralgia, myalgia, vasculitis and skeletal and soft tissue calcification. We review the literature and discuss the possible association between isotretinoin and immune dysfunction. The etiology of arthritis associated with vitamin A analog treatment remains obscure.

Topics: Acne Vulgaris; Administration, Oral; Adult; Antibodies, Antinuclear; Arthritis; Female; Humans; Isotretinoin; Synovitis

We report a case of acute sacroiliitis with severe disability after only 3 weeks of isotretinoin therapy with graduate reduction of pain, limitation and muscle incompetence after discontinuation of the drug and ACTH-depo injection and Ethodolac therapy. Naranjo probability scale indicated a probable relationship between isotretinoin therapy and bilateral sacroiliitis. We discussed possible mechanisms of sacroiliitis and disability due to isotretinoin treatment.

Topics: Acne Vulgaris; Adrenocorticotropic Hormone; Adult; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Arthritis; Dermatologic Agents; Disability Evaluation; Edema; Etodolac; Humans; Iatrogenic Disease; Isotretinoin; Low Back Pain; Magnetic Resonance Imaging; Male; Muscle Weakness; Radiography; Sacroiliac Joint; Treatment Outcome; Whole Body Imaging

Acne fulminans is the most severe form of inflammatory acne characterized by the acute onset of inflammatory nodules and plaques, most commonly on the chest and the back. The lesions undergo rapid suppuration, leaving ragged hemorrhagic ulcers. Typically, it affects adolescent males with a history of mild to moderate acne. The affected patients often have constitutional symptoms such as fever, malaise, arthralgias, and myalgias. Leukocytosis is commonly associated. Sacroiliitis is reported in 21% of acne fulminans patients in association with arthritis and in a few cases it is reported during isotretinoin treatment, suggesting the drug triggering.. We report a case of a young male patient in whom the induction of acne fulminans by systemic isotretinoin was associated with unilateral sacroiliitis.

Topics: Acne Vulgaris; Adolescent; Anti-Inflammatory Agents; Arthritis; Humans; Isotretinoin; Male; Physical Therapy Modalities; Radiography; Sacroiliac Joint

Isotretinoin, a medication for acne, has been reported to cause a variety of side effects on the musculoskeletal system. We present a case of sacroiliitis (a relatively uncommon feature) and sensorimotor demyelinating polyneuropathy, which has been reported previously in only a few cases during isotretinoin therapy. Clinical symptoms were improved after the withdrawal of isotretinoin and the follow-up electrophysiological study performed 2 years after the initial diagnosis of polyneuropathy showed mild improvement. Dermatologists are advised to be alert to symptoms of polyneuropathy and sacroiliitis during treatment with isotretinoin.

Topics: Acne Vulgaris; Adult; Arthritis; Demyelinating Diseases; Dermatologic Agents; Dose-Response Relationship, Drug; Humans; Isotretinoin; Male; Polyneuropathies; Radiography; Sacroiliac Joint; Treatment Outcome; Withholding Treatment

Topics: Acne Vulgaris; Adult; Arthralgia; Arthritis; Female; Hip Joint; Humans; Isotretinoin; Keratolytic Agents

Topics: Acne Vulgaris; Acute Disease; Adolescent; Adult; Arthritis; Female; Humans; Isotretinoin; Keratolytic Agents; Male

A patient with arthropathy associated with cystic acne, hidradenitis suppurativa, and perifolliculitis capitis abscedens et suffodiens who showed a dramatic response to isotretinoin is described. This, to our knowledge, is the first report documenting effective treatment of this condition, whose nosologic position with respect to other spondyloarthropathies associated with cutaneous disease is considered.

Topics: Acne Vulgaris; Acquired Hyperostosis Syndrome; Adult; Arthritis; Hidradenitis Suppurativa; Humans; Isotretinoin; Keratolytic Agents; Male; Scalp Dermatoses

Topics: Acne Vulgaris; Acute Disease; Adolescent; Ankle Joint; Arthritis; Follow-Up Studies; Humans; Isotretinoin; Keratolytic Agents; Male

Topics: Acne Vulgaris; Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Arthritis; Humans; Isotretinoin; Keratolytic Agents; Male

We report a case of acute arthritis of the knee which occurred in a dose-dependent manner during treatment with isotretinoin. Recurrence was seen at rechallenge. Only three observations of acute arthritis induced by isotretinoin have been reported in the literature. This side effect is rare and does not require drug withdrawal but rather an adapted dose.

Topics: Acne Vulgaris; Acute Disease; Adult; Arthritis; Humans; Isotretinoin; Knee Joint; Male

Topics: Acne Vulgaris; Adult; Arthritis; Humans; Isotretinoin; Leukocytosis; Male

Topics: Acne Vulgaris; Acute Disease; Adult; Arthritis; Humans; Isotretinoin; Male; Tretinoin

The induction of ceruloplasmin and metallothionein was investigated in rats with the early inflammatory phase of adjuvant arthritis. When examined at the peak of the acute inflammatory response, 5 days after adjuvant treatment, zinc given daily (2 mg/kg, intraperitoneally) increased serum ceruloplasmin levels by 2.0 times that found in nonarthritic rats and 1.2 times that found in non-zinc-treated arthritic rats. 13-cis-Retinoic acid (160 mg/kg, orally) given daily increased serum ceruloplasmin 2.2 and 2.7 times that found in nontreated arthritic rats when given alone and with zinc (2 mg/kg, intraperitoneally), respectively. Reduction in the inflammatory response was measured by weight of the adjuvant-injected paw, 5 days after adjuvant was administered. The reduction in inflammation was 13 and 19-20% for 13-cis-retinoic acid and zinc, respectively, when given alone, and between 26 and 31% when the treatments were combined. Zinc markedly increased liver metallothionein levels whereas 13-cis-retinoic acid was a much less potent inducer of the protein in liver. The results are discussed in light of the probable physiological roles of both ceruloplasmin and metallothionein.

Topics: Animals; Arthritis; Arthritis, Experimental; Ceruloplasmin; Isotretinoin; Male; Metallothionein; Rats; Rats, Inbred Strains; Tretinoin; Zinc

Topics: Acne Vulgaris; Adolescent; Arthritis; Diseases in Twins; Female; Humans; Isotretinoin; Male; Pregnancy; Tretinoin; Twins, Monozygotic

Treatment with isotretinoin (retinoic acid), which is frequently used in the control of acne, is associated with transient arthralgias in up to 16% of patients. We encountered two cases of acute, aseptic arthritis of the knee in male patients receiving isotretinoin, during the third week and third month of therapy. Synovial fluid obtained from one of the patients was noninflammatory. The drug concentration in the synovial fluid was 131 ng/mL--a level that was compatible with diffusion from the blood (simultaneous serum concentration, 229 ng/mL). Arthritis resolved in both patients without sequelae, despite continuation of drug treatment in one of them. This observation indicates that arthritis with joint effusion may complicate isotretinoin use; it also suggests that alternative measures should be considered before administering the drug to patients with rheumatologic disorders.

Topics: Acne Vulgaris; Acute Disease; Adult; Arthritis; Humans; Isotretinoin; Male; Tretinoin