Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, affects the ligaments around the spine. Sections of the ligaments turn into bone in this disorder, which is considered to be a form of degenerative arthritis.
The conversion of ligamental tissue to bone usually extends along the sides of the vertebrae of the spine. (This may be called flowing calcification.) Also, DISH is associated with inflammation (tendinitis) and calcification of the tendons, especially at the points at which the tendon attaches to the bones. When this happens, the patient is said to have developed bone spurs, especially in the heel and ankles (heel spurs).
DISH affects three or more vertebrae that are most often located in the chest or in the spine between the chest and pelvis. It is a disorder of older patients, more often affecting men than women ages 50-60. The disorder is often found in association with diabetes, high blood pressure, heart disease and obesity.
Because bone spurs are so often associated with DISH, intermittent stiffness of the spine, especially in the evening and upon arising in the morning, is often a sign of the disorder. Many people with DISH have trouble swallowing and moving their necks or backs. Usually such signs occur when bony overgrowths place pressure on nearby nerves (nerve compression or entrapment) causing irritation. DISH progresses slowly, and calcification may take several years to complete its course.
The exact cause of diffuse idiopathic skeletal hyperostosis is unknown. Changes in cartilage may cause the bony overgrowths to occur. This may be due to aging, trauma, or wear and tear in the course of a lengthy sports career. Disorders that involve disturbances in cartilage metabolism, such as diabetes mellitus or acromegaly, or certain inherited connective tissue disorders may also lead to DISH. (For more information, choose “diabetes mellitus,” “acromegaly,” or “connective tissue” as your search terms in the Rare Disease Database).
Diffuse idiopathic skeletal hyperostosis is a common subtype of osteoarthritis. About 19% of men older than 50 years present with DISH while only about 4% of women over the age of 50 years do so. For unknown reasons, a major ligament of the spine (posterior longitudinal) is calcified in 2% of a Japanese population while only about 0.16% of a similar Caucasian population will present with DISH in this same ligament.
DISH has been described as a phenomenon rather than a disease. Double-blind controlled studies have shown that DISH is not associated with any other pathology. Patients with DISH show no greater tendency towards arthritis, bursitis, tendinitis and back pain than do the control subjects. Patients diagnosed with DISH who have back pain show no difference in the character and duration of the pain.
The diagnostic criteria for DISH are fairly strict in order to distinguish this disorder from degenerative disc and joint disease and ankylosing spondylitis. At least the following must be present:
1. Calcification of at least four (4) contiguous vertebrae
2. Absence of disc disease and no compression of the discs
3. Vertebral joints should be mobile and free of packing pressure
Anti-inflammatory drugs, including non-steroid anti-inflammatory drugs (NSAIDS) are often prescribed. In relatively rare cases, surgery to correct deformities may be prescribed. Other treatment is symptomatic and supportive.
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