Musculoskeletal Symptoms with Long-term Acitretin Therapy for Psoriasis: An Age- and Sex-matched Retrospective Study

Abstract

Acitretin, an orally administered retinoid, has been part of the psoriasis treatment armamentarium since 1997. While much has been reported regarding the incidence of musculoskeletal symptoms associated with long-term systemic retinoid use, most studies have focused on the older retinoids, isotretinoin and etretinate, the pro-drug of acitretin. The retinoid-associated musculoskeletal symptoms described in the literature include arthralgia, myalgia, arthritis, myopathy and hyperostosis. Owing to acitretin's relatively young market life, few studies have been undertaken to assess its effects on the skeletal system. In this retrospective cohort study, we examine the incidence of musculoskeletal symptoms in patients with psoriasis treated with long-term acitretin, defined as more than 6 months. We performed a cross-sectional, age- and sex-matched survey of 53 patients diagnosed with psoriasis. Twenty-eight patients treated with long-term acitretin, mean length of treatment 3.68 years (range of 6 months to 10 years) were compared with 25 patients who had never received acitretin therapy. Patients were surveyed to identify the presence of back pain, joint pain, morning stiffness and decreased spinal range of motion. These symptoms served as surrogate markers for retinoid-induced musculoskeletal changes. We identify no increase in the incidence of musculoskeletal symptoms between patients with psoriasis who have taken long-term acitretin, and patients with psoriasis who have never taken acitretin.