Doctor's Notes on Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Diffuse idiopathic skeletal hyperostosis (DISH) (also called also known as Forestier's disease, spondylitis ossificans ligamentosa, spondylosis hyperostotica, and ankylosing hyperostosis of the spine) is a hardening of ligaments that causes bone to form in abnormal places. DISH most commonly affects the mid back (thoracic spine) but it can also affect the neck (cervical spine), lower back (lumbar spine), hips, heels, and other areas.
Symptoms of diffuse idiopathic skeletal hyperostosis include decreased range of motion of the spine (especially in the mid back) and pain in the affected area. If large bone spurs form in the neck, in rare cases they may cause difficulty breathing or trouble swallowing. Very rarely, large bone spurs in the neck or elsewhere in the spine can cause serious complications due to compression of the spinal cord. Bone spurs in the low back can put pressure on the spinal nerves and cause numbness and tingling in the legs. Other symptoms of diffuse idiopathic skeletal hyperostosis (DISH) include tenderness over sites where ligaments attach to bones.
Diffuse Idiopathic Skeletal Hyperostosis (DISH) Symptoms
Decreased range of motion of the spine, especially in the mid back, is the most common sign of DISH. DISH commonly causes pain in the affected area. For example, neck pain is common in people with DISH in the cervical spine (the spine in the neck).
If large bone spurs form in the neck, they can rarely cause difficulty breathing or trouble swallowing. Very rarely, large bone spurs in the neck or elsewhere in the spine can cause serious complications due to compression of the spinal cord. Bone spurs in the low back can put pressure on the spinal nerves and cause numbness and tingling in the legs.
Other signs of DISH include tenderness over sites where ligaments attach to bones, such as the back of the heel where the Achilles tendon attaches to bone.
The symptoms of DISH can be similar to those seen in other diseases affecting the spine or sites where tendons attach to bone including degenerative disc disease, degenerative spondylosis, ankylosing spondylitis, spondylolisthesis, spondyloarthropathy, and spinal arthritis.
Diffuse Idiopathic Skeletal Hyperostosis (DISH) Causes
The exact cause of DISH is not known. A variety of factors are thought to contribute to its development, such as metabolic conditions. For example, DISH is more common in obese people and those with diabetes, as well as up to 20% of people with acromegaly (a rare condition caused by abnormal levels of growth hormone). It is more common in men than women and the elderly. DISH is uncommon before age 40.
Ankylosing spondylitis (AS) is a type of arthritis that inflames the joints (vertebrae) in the spine. The most commonly affected part of the spine in the sacroiliac (SI) joint. This is the joint where the spine connects with the pelvis. The condition affects other joints in the body in some cases including the ribs, shoulders, knees, hips, and feet. The condition causes pain, stiffness, and discomfort along the length of the spine. Rarely, AS involves the bowel, eyes, lungs, and heart. Many people who have AS have mild, intermittent pain. Some have constant, severe pain. Some people experience a loss of flexibility in the spine due to AS.
Spondylitis means inflammation of the spine. Ankylosis is when bones fuse together. When vertebrae become inflamed and fuse together, the condition is called ankylosing spondylitis. AS is a type of spondyloarthropathy. Spondyloarthropathies are chronic, long-term joint diseases. The spondyloarthropathies include AS, psoriatic arthritis, reactive arthritis, and enteropathic arthritis, a type of arthritis that sometimes occurs in people who have inflammatory bowel disease. The most common symptom of spondyloarthropathy is lower back pain. Spondyloarthropathies have a tendency to run in families. Another name for spondyloarthropathies is spondyloarthritis. This refers to inflammatory conditions that involve the joints and the entheses (areas were tendons and ligaments attach to bones). Spondarthropathies may mimic rheumatoid arthritis in a variety of ways. However, spondarthropathies do not feature rheumatoid factor, antibodies that are present in many people who have rheumatoid arthritis.
Spondyloarthropathies are grouped into two main classes. Axial spondyloarthritis is inflammation of the spine and sacroiliac joints. Peripheral spondyloarthropathritis is inflammation that affects the peripheral joints.
Other less common names for ankylosing spondylitis are Marie Strümpell disease and Bechterew disease.
Rheumatoid Arthritis : What is Rheumatoid Arthritis? QuizQuestion
The term arthritis refers to stiffness in the joints.See Answer
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.