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DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH)

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DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH)

Diffuse idiopathic skeletal hyperostosis is a type of arthritis that is characterized by the calcification (hardening) of ligaments and connective tissues, the regions where tendons and ligaments connect to the bone.

  • Once the tendon and ligament harden, new growths called bone spurs can form where they connect to the bones.
  • This hardening is most often found in the spine but can also be found in the tissues around other joints of the body including elbows, knees, Achilles tendons, shoulder, hips, ankle, and even the head (skull).
  • Also known as Forestier’s disease, DISH is thought to be the second most common form of arthritis after osteoarthritis.
  • The condition is more prevalent in older people, and the risk of having the condition increases with age.
  • It is twice more common in males than in females.
  • Diffuse idiopathic skeletal hyperostosis can be progressive. It can also cause serious complications when bone spurs press on certain nerves in the lower back or neck.

CAUSES

Diffuse idiopathic skeletal hyperostosis can be caused by the buildup of calcium salts in the ligaments and tendons and the abnormal growth of new bones. Doctors are not certain what causes this to occur.

Risk factors associated with this condition include:

  • Being male
  • Being over the age of 50
  • Having diabetes and other conditions that raise insulin levels such as prediabetes, obesity, hyperinsulinemia.
  • Prolong use of certain medication such as isotretinoin which is used to treat skin conditions such as acne.
  • Having unusual spine anatomy

SYMPTOMS

Symptoms may vary depending on the area of the body affected, but they usually develop when the bone spurs begin to compress nearby nerves.

DISH does not often cause symptoms, however, if symptoms exist they may include:

  • Pain
  • Stiffness
  • Loss of range of motion
  • Hoarse voice or difficulty swallowing when nerves in the neck are compressed
  • Tingling, numbness, and/or weakness in the legs usually from compressed nerves in the lower back

DIAGNOSIS AND TREATMENT

To make a diagnosis, the doctor will carry out a thorough physical examination of your spines and joint. The doctor will lightly press on the spines and joint to feel for any abnormalities and also possibly check for your range of motion.

Imaging tests such as X-rays, CT scans, and MRIs can be used to look for changes in your spine and confirm a diagnosis.

Imaging tests can also be used to rule out other conditions.

TREATMENT

Treatment options cannot stop the hardening or bone growth associated with DISH, but treatment options may help to reduce pain and stiffness associated with the condition. Treatment options may include:

  • Medications such as corticosteroids injections, muscle relaxants, or over-the-counter pain relievers.
  • Physical therapy to help increase the range of motion.
  • In cases of severe complications, surgery may be needed. People who have difficulty swallowing as a result of bone spurs in the neck might need surgery to remove it.
  • Warm compresses can also ease pain and stiffness.