İzotretinoin Tedavisi Alan Akne Vulgaris Hastalarında Sakroiliit Prevelansının Değerlendirilmesi

Amaç: İzotretinoin, akne vulgaris tedavisinde oldukça etkili sentetik bir A vitamini türevidir. Son yıllarda literatürde izotretinoin tedavisine bağlı birkaç sakroiliit olgusu ve az sayıda klinik kohort çalışma bildirilmiştir. Bu çalışmanın amacı akne vulgaris hastalarında izotretinoine bağlı sakroiliit prevalansını değerlendirmektir. Gereç ve Yöntem: Dermatoloji polikliniğinde izotretinoin tedavisi başlanan 468 akne vulgaris hastasından tedavi ile ilişkilendirilen bel-sırt ağrıları ve/veya sabah tutukluğu tarifleyen ve romatoloji polikliniğine yönlendirilen 99 hasta çalışmaya dahil edildi ve kayıtları retrospektif olarak incelendi. Enflamatuvar bel ağrısı (İBA), tek romatolog tarafından Uluslararası Spondiloartrit Değerlendirme Derneği (ASAS) kriterleri kullanılarak tespit edildi. ASAS kriterlerini karşılayan hastalar direkt pelvis radyografisi ile ve sakroiliit şüphesi olan hastalar sakroiliak eklem (SİE) manyetik rezonans görüntüleme (MRG) ile değerlendirildi. Bulgular: Hastaların 79’u kadındı ve tüm hastaların yaş ortalaması 19,8±3,6 yıldı. Günlük ortalama izotretinoin dozu 39,1±2,7 mg ve ortalama tedavi süresi 6,2±0,6 aydı. İzotretinoin tedavisi sırasında hastaların %24,2’sinde mekanik bel ağrısı ve %9,1’inde ise İBA saptandı. Cinsiyete göre mekanik bel ağrısı ve İBA sıklığı bakımından istatistiksel açıdan fark saptanmadı (p>0,05). SİE MRG’de sakroiliit sıklığı %4,04 (n=4) olarak belirlendi. Üç hastada tek taraflı, 1 hastada ise bilateral sakroiliit tespit edildi. Sakroiliit saptanan hastaların hepsi kadın hastalardı. Sonuç: Bu çalışmada anormal fizik muayene bulgularına dayalı olarak izotretinoin ilişkili sakroiliit prelavansı vurgulanmıştır. Her ne kadar fizik muayene ve İBA tespiti sakroiliitin saptanılmasında çok duyarlı olmasa da erken tespitinde yol göstericidir. İzotretinoin tedavisi alan akne vulgaris hastaları özellikle bel ağrısı tariflediklerinde sakroiliit gelişimi yönünden değerlendirilmelidir.

Evaluation of the Prevalence of Sacroileitis in Acne Vulgaris Patients Treated with Isotretinoin

Objectives: Isotretinoin is a synthetic vitamin A derivative that is highly effective in acne vulgaris. A few cases and cohort studies about sacroileitis due to isotretinoin have been reported recently. The aim in this study is to evaluate the prevalence of isotretinoin-induced sacroileitis in patients with acne vulgaris. Materials and Methods: Of the 468 acne vulgaris patients who were started on isotretinoin in the dermatology outpatient clinic, 99 patients who described back pain and/or morning stiffness associated with treatment and were referred to the rheumatology outpatient clinic were included in the study and reviewed retrospectively. Inflammatory low back pain (IBP) was evaluated using the Assessment of SpondyloArthritis International Society (ASAS) criteria by the same rheumatologist. Patients meeting ASAS criteria were evaluated with direct pelvis radiography and when necessary with sacroiliac joint magnetic resonance imaging (SIJ MRI). Results: Of the patients, 79 were female and the mean age of all patients was 19.8±3.6 years. The mean daily isotretinoin dose was 39.1±2.7 mg and the mean duration of treatment was 6.2±0.6 months. During isotretinoin treatment, mechanical low back pain was detected in 24.2% of the patients and IBP in 9.1%. There was no statistical difference in terms of mechanical low back pain and IBP frequency according to gender (p>0.05). The frequency of sacroileitis in SIJ MRI was determined as 4.04% (n=4). Unilateral sacroileitis was detected in 3 patients and bilateral sacroileitis in one patient. All patients with sacroileitis were female. Conclusion: In this study, the prevalence of isotretinoin-associated sacroileitis was emphasized based on abnormal physical examination findings. Although physical examination and detection of IBP are not very sensitive, they help the early detection of isotretinoin-induced sacroileitis. Acne vulgaris patients treated with isotretinoin should be evaluated for the development of sacroileitis, especially when they describe low back pain.

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