Sacroiliitis associated with isotretinoin use: a clinical case and literature review

Abstract

Isotretinoin is an effective treatment for severe forms of acne vulgaris; however, its use may be accompanied by rare side effects involving the musculoskeletal system, including sacroiliitis. This article presents a clinical case of bilateral sacroiliitis induced by isotretinoin in an HLA-B27-positive patient. A literature review is provided regarding the frequency of this complication, its pathophysiological mechanisms, disease progression, and remission duration after discontinuation of the drug. The role of immunological factors, including the cytokine balance, matrix metalloproteinase (MMP) activity, as well as genetic factors (HLA-B27), in the development of joint lesions during isotretinoin therapy is discussed. It is determined that sacroiliitis most commonly occurs in the first months of treatment, usually resolves after discontinuation of the drug, but in some cases may become chronic, requiring prolonged therapy with nonsteroidal anti-inflammatory drugs or other medications. The analysis of the data emphasizes the importance of an interdisciplinary approach in managing patients receiving systemic retinoids, especially those with genetic predisposition, for timely diagnosis and treatment optimization.