A Controlled Study of Diffuse Idiopathic Skeletal Hyperostosis Clinical Features and Functional Status

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but little-studied disorder in the elderly that is infrequently recognized by physicians. Its prevalence in adults over 40 years of age is estimated at 3.8% for men and 2.6% for women. The present case-control study evaluated the history of pain and stiffness, radicular pain and enthesitis, physical findings on the musculoskeletal examination, and level of physical and psychologic disability in 130 persons: 56 patients with DISH, 43 control patients with spondylosis of the lumbar spine, and 31 healthy control patients. DISH patients were more likely to report a past history of upper extremity pain, medial epicondylitis of the elbow, enthesitis of the patella or heel, or dysphagia than spondylosis patients. They had more extremity and spinal stiffness and pain than healthy controls. DISH patients weighed more at a young age and their body mass index was greater at the time of the clinical evaluation than either spondylosis or healthy control patients. On musculoskeletal examination, DISH patients had a greater reduction in neck rotation and thoracic movements than either spondylosis patients or healthy controls, and had a greater reduction in lumbar movement than healthy controls. DISH patients had similar levels of spinal disability and physical disability overall, as measured by standardized indices, as spondylosis patients. No differences were found among the 3 groups of patients for the laboratory tests evaluated. DISH is clearly a distinct disorder with signs and symptoms that distinguish it from other causes of spinal complaint and from healthy individuals. It has the potential to cause major disability. Future studies need to address the natural history of DISH, pursue pathogenic mechanisms, and evaluate treatment modalities.

Imaging Findings Suggestive of Axial Spondyloarthritis in Diffuse Idiopathic Skeletal Hyperostosis

“…Back pain, usually lasting for >3 months, was present in nearly all patients of this study. This finding is in line with previous data suggesting that DISH, which was first described as a radiologic state, could be associated with spinal symptoms such as pain or stiffness, which could be worse than for patients with spondylosis (29). The substantial proportion of patients reporting axial SpA-like symptoms in this study illustrates the potential issue for the clinician to discriminate between these 2 diseases, which may share common clinical features such as postural abnormalities (15).…”

Ectopic calcification among families in the Azores: Clinical and radiologic manifestations in families with diffuse idiopathic skeletal hyperostosis and chondrocalcinosis

“…There have been few systematic studies of the clinical consequences of DISH (5). One of the first reported studies on this condition showed that stiffness and mild middle-to-low back pain were found in 80% of patients, dysphagia was present in 28%, elbow pain in 13%, and heel problems in 23% (6).…”

Spinal hyperostosis in humans and companion animals

“…Various metabolic, endocrinological, genetic, and environmental factors have been postulated but none has generally been agreed upon (Mata et al 1997;Li et al 2007). DISH is often linked to obesity (Forestier & Rotes-Querol 1950;Resnick & Niwayama 1976;Utsinger 1985;Denko et al 1994;Vezyroglou et al 1996;Mata et al 1997;el Miedany et al 2000;Belanger & Rowe 2001;Kiss et al 2002a;Mader et al 2005).…”

“…Some authors suggested that hyperglycemia was the most useful laboratory abnormality concurrent with DISH (Utsinger 1985). Others found no significant difference in glucose levels between patients with and without DISH (Denko et al 1994;Mata et al 1997). The relationship with type 2 DM (or non-insulin dependent DM) and DISH was often postulated, but remains controversial (Kiss et al 2002a;Sarzi-Puttini & Atzeni 2004;Li et al 2007).…”

“…In the biomedical literature in the1960s and 1970s, signs nowadays described to DISH were by some authors still considered to be a type of (severe) spondylosis (Ott et al 1963;Hajkova et al 1965;Schmorl & Junghanns 1968;Vernon-Roberts & Pirie 1977). Later, the distinction between spondylosis and DISH has been made more frequently and currently spondylosis and DISH are considered to be distinct disorders in humans (Mata et al 1997;Kiss et al 2002a;Sarzi-Puttini & Atzeni 2004). In the veterinary literature, Wright (1982b) acknowledged the occurrence of several different types of spinal bony outgrowths, and described the types to be related to different disorders.…”