title: The prevalence of sacroiliitis in patients with acne vulgaris using isotretinoin.
abstract: OBJECTIVE
  Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit in the skin. Isotretinoin is a synthetic vitamin A derivative regarded as the most effective agent in the treatment of acne. There have recently been increasing reports of adverse effects of isotretinoin on the skeletal system. Our aim in this study was to evaluate the rheumatic side-effects triggered by this drug, and particularly the prevalence of sacroiliitis.
  
  
  METHODS
  A total of 73 patients receiving isotretinoin due to moderate or severe acne vulgaris were included. All patients were questioned about inflammatory low back pain and musculoskeletal pains during the treatment process. Inflammatory low back pain was evaluated using Assessment of Spondyloarthritis International Society (ASAS) criteria. Patients meeting ASAS criteria were evaluated with radiography and when necessary with sacroiliac magnetic resonance.
  
  
  RESULTS
  The dose range for isotretinoin was between 0.4 and 0.8 mg/kg/day (mean 0.53 mg/kg/day). Treatment lasted for 6-8 months (mean 6.8 months). Lethargy was determined in 37 (50.7%) patients, myalgia in 31 (42.5%) and low back pain in 36 (49.3%). Mechanical low back pain symptoms were present in 20 of the patients describing low back pain and inflammatory low back pain in 16. Acute sacroiliitis was determined in six patients (8.2%) following a sacroiliac magnetic resonance imaging (MRI). Five (83.3%) of the patients with sacroiliitis were female and one (16.7%) was male. No statistically significant difference was determined between male and female patients in terms of prevalence of sacroiliitis (p = 0.392).
  
  
  CONCLUSIONS
  The incidence of sacroiliitis in patients using isotretinoin is quite high. Patients using isotretinoin must be questioned about sacroiliitis findings and must be subjected to advanced assessment when necessary. Further studies regarding the development of sacroiliitis under isotretinoin therapy are now needed.
authors.affiliation: a Dermatology Department, School of Medicine, Karadeniz Technical University , Trabzon , Turkey and.
authors.forename: Leyla
authors.initials: L
authors.lastname: Baykal Selçuk
authors.affiliation: a Dermatology Department, School of Medicine, Karadeniz Technical University , Trabzon , Turkey and.
authors.forename: Deniz
authors.initials: D
authors.lastname: Aksu Arıca
authors.affiliation: b Physical Therapy and Rehabilitation Department, Maçka Ömer Burhanoğlu Physical Therapy and Rehabilitation Hospital , Trabzon , Turkey.
authors.forename: Hanife
authors.initials: H
authors.lastname: Baykal Şahin
authors.affiliation: a Dermatology Department, School of Medicine, Karadeniz Technical University , Trabzon , Turkey and.
authors.forename: Savas
authors.initials: S
authors.lastname: Yaylı
authors.affiliation: a Dermatology Department, School of Medicine, Karadeniz Technical University , Trabzon , Turkey and.
authors.forename: Sevgi
authors.initials: S
authors.lastname: Bahadır
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D015474:Isotretinoin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D017116:Low Back Pain / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D015995:Prevalence; D011446:Prospective Studies; D011859:Radiography; D058566:Sacroiliitis / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D015474:Isotretinoin
keywords: Acne vulgaris; isotretinoin; low back; pain; sacroiliitis