Ankylosing Spondylitis Diary and Diet Research

Oral Retinoid Therapy: Special Considerations
Retinoids are naturally or synthetically derived from Vitamin A (retinol) and have anti-inflammatory, antikeratinizing, and antiproliferative effects on the skin. Acitretin is the only oral retinoid approved for psoriasis therapy in the United States. The drug has demonstrated good to excellent therapeutic results, especially in combination with other conventional treatments.

• Adverse Effects of Oral Retinoids
  Although oral retinoids have numerous side effects, they are generally not serious, except for teratogenicity. The most common and frequently troublesome side effects are dryness of the skin and mucous membranes, hair loss, and nail changes. Patients taking acitretin for years may develop diffuse idiopathic skeletal hyperostosis-like involvement of the spine. Extraspinal tendon and ligament calcifications are more common. Many of these changes are asymptomatic, and well- established guidelines for monitoring skeletal toxicity are lacking.

• Lipid Effects
  Retinoids cause hyperlipidemia, especially elevations of serum triglyceride, and decreases in high-density lipoprotein cholesterol. Experimental evidence supports the hypothesis that retinoids induce increased synthesis of apoprotein B and triglycerides. Fish oil supplements given to patients receiving acitretin significantly decrease triglyceride levels. Gemfibrozil or atorvastatin calcium are useful for treating patients with hyperlipidemia due to acitretin who do not respond to dietary manipulation and dose reductions of acitretin.¹⁶

• Use In Pregnancy
  Acitretin is reserved for men or for women who are not of childbearing age. Fertile women with severe psoriasis who take acitretin must follow two-method contraception or abstinence and have monthly pregnancy tests. Acitretin may be converted to etretinate, which has a long half-life and is stored in fat. Therefore, the manufacturer’s guidelines warn that patients must abstain from drinking alcohol during treatment and must not conceive for 3 years after terminating treatment.