title: Isotretinoin-induced Spondyloarthropathy-related Symptoms: A Prospective Study.
abstract: OBJECTIVE
  Acne vulgaris is a chronic inflammatory disease involving the pilosebaceous unit of the skin. Isotretinoin is a systemic retinoid that is often used as an effective treatment option for severe and treatment-resistant acne. Isotretinoin may also cause rheumatologic symptoms. The aim of this prospective observational study was to present followup results regarding the rheumatologic symptoms of patients who received systemic therapy for the treatment of acne (isotretinoin and tetracycline).
  
  
  METHODS
  For inclusion in the study, all consecutive patients with acne who were aged > 18 years were evaluated by the same dermatologist. The first 42 consecutive patients were included in the isotretinoin group, and after matching for age and sex, 32 consecutive patients were included in the tetracycline group. Isotretinoin treatment was planned as an average dose of 30 mg daily and a total dose of 120-150 mg/kg for 4-6 months. The patients were administered a dose of 1 g/day of tetracycline as 2 equal doses for 3 months.
  
  
  RESULTS
  Forty-two patients diagnosed with acne vulgaris were treated with isotretinoin 20.6 ± 4.4 (male/female: 17/22), and 32 patients were treated with tetracycline 20.6 ± 2.7 (male/female: 8/24). There was no significant difference between the 2 groups with respect to age and sex. Unilateral Achilles enthesopathy developed in 3 patients, whereas both Achilles enthesopathy and unilateral sacroiliitis developed in 1 patient. Inflammatory back pain developed in 6 patients in the isotretinoin group.
  
  
  CONCLUSIONS
  To our knowledge, this was the first prospective observational study that assessed the rheumatologic symptoms of isotretinoin treatment. The spondyloarthropathy findings were identified in 23.1% of the patients who used isotretinoin.
authors.affiliation: From the Department of Internal Medicine, and Department of Dermatology, and Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.S. Alkan, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; N. Kayiran, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; O. Zengin, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; A. Kalem, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; G. Kimyon, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; E.O. Kilinc, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; Y. Pehlivan, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University; N. Kirtak, MD, Professor, Department of Dermatology, Gaziantep University Faculty of Medicine; A.M. Onat, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University. smtalkan@hotmail.com.
authors.forename: Samet
authors.initials: S
authors.lastname: Alkan
authors.affiliation: From the Department of Internal Medicine, and Department of Dermatology, and Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.S. Alkan, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; N. Kayiran, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; O. Zengin, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; A. Kalem, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; G. Kimyon, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; E.O. Kilinc, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; Y. Pehlivan, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University; N. Kirtak, MD, Professor, Department of Dermatology, Gaziantep University Faculty of Medicine; A.M. Onat, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University.
authors.forename: Nuriye
authors.initials: N
authors.lastname: Kayiran
authors.affiliation: From the Department of Internal Medicine, and Department of Dermatology, and Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.S. Alkan, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; N. Kayiran, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; O. Zengin, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; A. Kalem, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; G. Kimyon, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; E.O. Kilinc, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; Y. Pehlivan, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University; N. Kirtak, MD, Professor, Department of Dermatology, Gaziantep University Faculty of Medicine; A.M. Onat, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University.
authors.forename: Orhan
authors.initials: O
authors.lastname: Zengin
authors.affiliation: From the Department of Internal Medicine, and Department of Dermatology, and Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.S. Alkan, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; N. Kayiran, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; O. Zengin, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; A. Kalem, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; G. Kimyon, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; E.O. Kilinc, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; Y. Pehlivan, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University; N. Kirtak, MD, Professor, Department of Dermatology, Gaziantep University Faculty of Medicine; A.M. Onat, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University.
authors.forename: Ali
authors.initials: A
authors.lastname: Kalem
authors.affiliation: From the Department of Internal Medicine, and Department of Dermatology, and Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.S. Alkan, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; N. Kayiran, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; O. Zengin, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; A. Kalem, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; G. Kimyon, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; E.O. Kilinc, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; Y. Pehlivan, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University; N. Kirtak, MD, Professor, Department of Dermatology, Gaziantep University Faculty of Medicine; A.M. Onat, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University.
authors.forename: Gezmis
authors.initials: G
authors.lastname: Kimyon
authors.affiliation: From the Department of Internal Medicine, and Department of Dermatology, and Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.S. Alkan, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; N. Kayiran, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; O. Zengin, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; A. Kalem, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; G. Kimyon, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; E.O. Kilinc, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; Y. Pehlivan, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University; N. Kirtak, MD, Professor, Department of Dermatology, Gaziantep University Faculty of Medicine; A.M. Onat, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University.
authors.forename: Emine Ozkul
authors.initials: EO
authors.lastname: Kilinc
authors.affiliation: From the Department of Internal Medicine, and Department of Dermatology, and Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.S. Alkan, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; N. Kayiran, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; O. Zengin, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; A. Kalem, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; G. Kimyon, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; E.O. Kilinc, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; Y. Pehlivan, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University; N. Kirtak, MD, Professor, Department of Dermatology, Gaziantep University Faculty of Medicine; A.M. Onat, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University.
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Pehlivan
authors.affiliation: From the Department of Internal Medicine, and Department of Dermatology, and Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.S. Alkan, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; N. Kayiran, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; O. Zengin, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; A. Kalem, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; G. Kimyon, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; E.O. Kilinc, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; Y. Pehlivan, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University; N. Kirtak, MD, Professor, Department of Dermatology, Gaziantep University Faculty of Medicine; A.M. Onat, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University.
authors.forename: Necmettin
authors.initials: N
authors.lastname: Kirtak
authors.affiliation: From the Department of Internal Medicine, and Department of Dermatology, and Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.S. Alkan, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; N. Kayiran, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; O. Zengin, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; A. Kalem, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; G. Kimyon, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; E.O. Kilinc, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; Y. Pehlivan, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University; N. Kirtak, MD, Professor, Department of Dermatology, Gaziantep University Faculty of Medicine; A.M. Onat, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University.
authors.forename: Ahmet Mesut
authors.initials: AM
authors.lastname: Onat
authors.affiliation: From the Department of Internal Medicine, and Department of Dermatology, and Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University, Gaziantep; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.S. Alkan, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; N. Kayiran, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; O. Zengin, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; A. Kalem, MD, Research Assistant, Department of Internal Medicine, Gaziantep University Faculty of Medicine; G. Kimyon, MD, Rheumatology Specialist, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; E.O. Kilinc, MD, Dermatology Specialist, Department of Dermatology, Gaziantep University Faculty of Medicine; Y. Pehlivan, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Uludağ University; N. Kirtak, MD, Professor, Department of Dermatology, Gaziantep University Faculty of Medicine; A.M. Onat, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University; B. Kisacik, MD, Associate Professor, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gaziantep University.
authors.forename: Bunyamin
authors.initials: B
authors.lastname: Kisacik
mesh_terms: D000152:Acne Vulgaris / Q000175:diagnosis / Q000188:drug therapy*; D000293:Adolescent; D017677:Age Distribution; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015474:Isotretinoin / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D025242:Spondylarthropathies / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D013752:Tetracycline / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D015474:Isotretinoin; D013752:Tetracycline
keywords: ENTHESITIS; INFLAMMATORY LOW BACK PAIN; ISOTRETINOIN; SPONDYLOARTHROPATHY