diffuse idiopathic skeletal hyperostosis (DISH, Forestier disease, ankylosing hyperostosis of the spine, spondylosis hyperostotica)
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Introduction
Variant of primary osteoarthritis.
Etiology
Epidemiology
Pathology
- non-inflammatory flowing ossification along anterolateral aspect of vertebral bodies (>= 4)
- may occur with or without osteoarthritis of the spine or inflammatory arthritis[2]
- represents a separate finding of ectopic calcification of spinal ligaments & entheses[2]
Clinical manifestations
- generally asymptomatic or minimally symptomatic
- occasional back pain
- case of 76-year-old man with 10-year history of progressive pain & stiffness in the thoracic & lumbar spine.
- patients are frequently obese
- diabetes or glucose intolerance (60%)
- mild back stiffness
- reduced range of motion, esp. at the thoracic spine[2]
- difficulty bending
- dysphagia may result from anterior osteophytes in the cervical spine compressing the esophagus[7]
- airway obstruction may result from anterior osteophytes in the cervical spine compressing the trachea[7]
Radiology
- radiograph of spine
- no vertically bridging syndesmophytes
- osteophytes connecting 4 or more vertebrae
- hyperostosis in the cervical spine occurs the anterior inferior lip of the vertebra, resulting in a downward-pointing spur
- hyperostosis in the lumbar spine results in spurs tending to point upward
- complete bridging of the lumbar disk space is unusual
- calcification of anterior longitudinal ligaments[2]
- encroachment of intervertebral foramina by osteophytes
- bridging horizontal syndesphophytes[2]
- calcification of pelvic & spinal ligaments
- radiograph of saroiliac joint
- absence of sacroiliac joint inflammatory changes (erosions)
- radiographs
- calcification of enthesis (where tendons & ligaments insert into bone)
- osteophytes at sites of osteoarthritis
- acetabular, olecranon, calcaneus & patellar spurs
- hypertrophic bone formation after joint arthroplasty
Complications
- dysphagia (see Pathology above)
- airway obstruction (see Pathology above)
- unstable vertebral fractures
- spinal stenosis
- myelopathy
Differential diagnosis
- ankylosing spondylitis (vertically bridging syndesmophytes)[2][3]
- generally begins in 2nd or 3rd decade of life
- onset after age 40 is unusual
- generally begins in 2nd or 3rd decade of life
Management
- no treatment, none usually necessary
More general terms
Additional terms
References
- ↑ Jump up to: 1.0 1.1 Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 832
- ↑ Jump up to: 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 Medical Knowledge Self Assessment Program (MKSAP) 11, 16,17, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2022
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Jump up to: 3.0 3.1 Olivieri I, D'Angelo S, Palazzi C, Padula A, Mader R, Khan MA. Diffuse idiopathic skeletal hyperostosis: differentiation from ankylosing spondylitis. Curr Rheumatol Rep. 2009 Oct;11(5):321-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19772826
- ↑ Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013 Dec;9(12):741-50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24189840
- ↑ Westerveld LA, van Ufford HM, Verlaan JJ, Oner FC. The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in The Netherlands. J Rheumatol. 2008 Aug;35(8):1635-8. Epub 2008 Jun 1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18528963
- ↑ Jump up to: 6.0 6.1 6.2 Fournier DE, Leung AE, Battie MC, Seguin CA. Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and early-phase DISH across the lifespan of an American population. Rheumatology (Oxford). 2024 Apr 2;63(4):1153-1161. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37481711 PMCID: PMC10986808 Free PMC article. https://pmc.ncbi.nlm.nih.gov/articles/PMC10986808/
- ↑ Jump up to: 7.0 7.1 7.2 Harlianto NI, Kuperus JS, Mohamed Hoesein FAA, et al. Diffuse idiopathic skeletal hyperostosis of the cervical spine causing dysphagia and airway obstruction: an updated systematic review. Spine J. 2022;22(9):1490-1503 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35283294 https://www.thespinejournalonline.com/article/S1529-9430(22)00100-0/fulltext
- ↑ Le HV, Wick JB, Van BW, Klineberg EO. Diffuse idiopathic skeletal hyperostosis of the spine: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. 2021;29(24):1044-1051 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34559699 Review