Acitretin-induced enthesitis in a patient with psoriatic arthritis

Vincent, Véronique; Zabraniecki, Laurent; Loustau, O.; Godfrin, Bertrand; Latour, Frédérique Bertrand; Railhac, J.J.; Fournie, B.

doi:10.1016/j.jbspin.2004.06.004

Cited by 19 publications

(9 citation statements)

References 13 publications

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“…Even if we adjusted the GUESS score according to all of the above-mentioned confounding factors, the adjusted GUESS score value was still significantly higher in cases than in controls, which supported that the presence of enthesopathy in our patients is independent from the confounding. As far as iatrogenic causes of enthesopathy, retinoids are known to induce hyperostosis, most notably when they are used in high dosages and over long periods;27 therefore, we included in the study only patients that never received retinoids. The role of ageing on tendon thickness is uncertain, although more recently it has been reported that Achilles tendon thickness was similar in young and middle-aged people 28.…”

Section: Discussionmentioning

confidence: 99%

Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case–control study

Gisondi

Tinazzi

El-Dalati

et al. 2008

Annals of the Rheumatic Diseases

261

181

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Background: Psoriasis is associated with a form of spondyloarthropathy in 10-30% of cases. A major feature of psoriatic arthritis is enthesitis. In some patients with psoriasis the presence of enthesitis could be underdiagnosed. Objective: To investigate the presence of lower limbs entheseal abnormalities in patients with chronic plaque psoriasis without signs and symptoms of psoriatic arthritis. Methods: Thirty patients with psoriasis and 30 controls underwent ultrasonographic evaluation of Achilles, quadriceps, patellar entheses and plantar aponeurosis. Ultrasonographic findings were scored according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Results: Mean GUESS score was significantly higher in patients with psoriasis as compared with controls: 7.9 (0.6) vs 2.9 (0.3); p,0.0001. In particular, the thickness of all tendons examined was significant higher in cases than in controls (p,0.0001), as well as the number of enthesophytes in all sites examined. In both cases and controls, the GUESS score was directly correlated with age (r = 0.22; p = 0.008), body mass index (r = 0.23, p = 0.0067) and waist circumference (r = 0.17; p = 0.02). In contrast, the GUESS score was not correlated with the duration and severity of psoriasis according to the Psoriasis Area and Severity Index (r = 0.03; p = 0.8) and body surface area involvement (r = 0.07; p = 0.6). Conclusions: Entheseal abnormalities can be documented by ultrasonography in clinically asymptomatic patients with psoriasis. These findings could be related to a subclinical entheseal psoriatic inflammation. We suggest close follow-up of patients with psoriasis with entheseal abnormalities for early diagnosis of psoriatic arthritis.

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Section: Discussionmentioning

confidence: 99%

Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case–control study

Gisondi

Tinazzi

El-Dalati

et al. 2008

Annals of the Rheumatic Diseases

261

181

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“…To date, no correlation between the occurrence of diffuse idiopathic hyperostosis and the duration of treatment has been shown (52). Occasionally severe hyperostosis may also be induced (53). In addition to hyperostosis of the vertebral column, peripheral enthisitis may be induced, especially at the calcaneus, knee, pelvis, shoulder, and interosseous membrane of the forearm (53–56).…”

mentioning

confidence: 99%

Update on retinoid therapy of psoriasis in: an update on the use of retinoids in dermatology

Kerkhof

2006

Dermatol Ther

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Both in the topical and systemic treatment of psoriasis, retinoids are mainstays. In this chapter the history and modes of actions of retinoids are presented. Tazarotene and acitretin are the only retinoids that are available in both topical and systemic formulations. A more extensive description of their pharmacology, modes of action, indications and contraindications, clinical results, and treatment strategies will be presented. Finally, retinoid X receptor ligands and retinoic acid metabolism blocking agents will be introduced as potential future retinoid mimetics in psoriasis.

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“… 1 , 2 , 10 , 11 Although the exact mechanism by which acitretin induces DISH remains unknown, high levels of vitamin A and increased levels of growth hormones might be involved in the pathophysiology. 12 …”

Section: Discussionmentioning

confidence: 99%

Severe acitretin-induced diffuse idiopathic skeletal hyperostosis: a case report

et al. 2020

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Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier–Rotes–Querol disease, is a systemic noninflammatory disease characterized by ossification of the entheses. DISH predominantly affects the spine. Although peripheral involvement is also often reported, it rarely affects patients’ function. A 77-year-old man presented to our emergency department because of incapacitating pain and stiffness in the spine and hips. The patient had been diagnosed with biopsy-proven mycosis fungoides 3 years earlier and had been treated with oral acitretin at 25 to 50 mg daily since diagnosis. However, the patient gradually developed a severely limited range of motion in his spine and hips (left > right), significantly impairing his mobility and activities of daily living. Cervical and dorsolumbar radiographs showed extensive ossification along the anterior longitudinal ligament; this finding was compatible with DISH and had not been present in radiographs taken 3 years earlier. Pelvic radiographs showed multiple enthesophytes predominantly around the coxofemoral joints. DISH has been reported as a possible long-term adverse effect of acitretin. Despite optimal conservative treatment, the patient remained severely impaired and thus finally underwent extensive osteophyte excision and total hip replacement on the left side. His acitretin therapy was also stopped to prevent further progression of his DISH.

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Acitretin-induced enthesitis in a patient with psoriatic arthritis

Cited by 19 publications

References 13 publications

Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case–control study

Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case–control study

Update on retinoid therapy of psoriasis in: an update on the use of retinoids in dermatology

Severe acitretin-induced diffuse idiopathic skeletal hyperostosis: a case report

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