Diffuse idiopathic skeletal hyperostosis

Diffuse idiopathic skeletal hyperostosis
Classification and external resources
OMIM	106400
DiseasesDB	4932
eMedicine	article/1258514 article/388973

Diffuse idiopathic skeletal hyperostosis (DISH) is a spondyloarthropathy also known as Forestier's disease and ankylosing Hyperostosis. It is a noninflammatory disease, with the principal manifestation being calcification and ossification of spinal ligaments and the regions where tendons and ligaments attach to bone (entheses). the most common abnormality is bilateral calcification seen on both side of the thoracic spine^[1][2]

Etiology

The exact cause is unknown. Mechanical factors, dietary and long term use of some antidepressants may be of significance. There is a correlation between these factors but NOT a cause or affect. It also is a cause of "bamboo spine," a fusion of the vertebral column causing the spine to curve forward. The distinctive radiological feature of DISH is the continuous linear calcification along the antero-medial aspect of the thoracic spine. the disease is usually found in people in their 60's and up and is extremely rare in people in their 40's and 30's. the disease can spread to any joint of the body affecting neck, shoulders, ribs, hips, pelvis, knees, ankles , hands. the disease is not fatal , how ever some of the complications due to the progression can be. Complications are as follows, paralysis , disphagia (the inability to swallow), and pulmonary infections. although Forestier's disease acts extremely similarly to that of ankylosing spondylitis, these two are totally separate diseases. A.S is a genetic disease with identifiable marks, and affects organs. Forestier's disease has no indication of a genetic link, and does not affect organs other than the lungs which is only indirectly due to the fusion of the rib cage. information was gathered from DR. DANIAL SCIUBBA ,Neurology dept. at Johns Hopkins hospital, DR. ANTHONY REGINATO, rheumatologist from Mass General HOSPITAL. DR DE ASLA also at MASS GENERAL HOSPITAL. other links are wrongdiagnoses.com. NIH, NORD.

Forestier, J., Lagier, R.; Ankylosing hyperostosis of the spine. Clin. Orthop. 1971; 74:65</ref> Treatment of acne with vitamin derived retinoids was noticed to be associated with similar manifestations in some patients especially with Etretinate^[3] which is no longer available for clinical use. other retinoids, like acitretin may cause extraspinal hyperostosis.^[4]

Symptoms

It can be present as a radiological abnormality, mentioned above, without any symptoms. The usual complaint is with thoracic spine pain. This occurs in around 80% of patients. Morning stiffness is also noticed in almost two thirds of patients. increased incidence of dysphagia is also reported in some series of cases.^[5][6] Similar calcification and ossification may be seen at peripheral entheseal sites, including: the shoulder, iliac crest, ischial tuberosity, trochanters of the hip, tibial tuberosities, patellae, and bones of the hands and/or feet.^[7]

Treatment

As areas of the spine and tendons can become inflamed NSAIDs such as ibuprofen and Naproxen can be helpful in both relieving pain and inflammation of DISH. It is hoped that by minimizing inflammation in these areas, further calcification of tendons and ligaments of the spine leading to calcific bony outgrowths (osteophytes) will be prevented. Physiotherapy to increase the spines range of motion may be beneficial.

See also

• Ankylosing Spondylitis
• Osteoarthritis.
• Retinoids.
• Enthesitis.

References

1. ^ Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH).Resnick D; Niwayama G Radiology 1976 Jun;119(3):559-68 PMID 935390
2. ^ Diffuse skeletal abnormalities in Forestier disease.Arch Intern Med 1976 Jul;136(7):763-8 PMID 938166
3. ^ DiGiovanna JJ; Helfgott RK; Gerber LH; Peck GL Extraspinal tendon and ligament calcification associated with long-term therapy with etretinate SO N Engl J Med 6 November 1986;315(19):1177-82. PMID 3463863
4. ^ DiGiovanna JJ Isotretinoin effects on bone. J Am Acad Dermatol 2001 Nov;45(5):S176-82.
5. ^ Utsinger, PD. Diffuse idiopathic skeletal hyperostosis. Clin Rheum Dis 1985; 11:325.
6. ^ A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status.Mata S; Fortin PR; Fitzcharles MA; Starr MR; Joseph L; Watts CS; Gore B; Rosenberg E; Chhem RK; Esdaile JM Medicine (Baltimore) 1997 Mar;76(2):104-17.
7. ^ A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status.Mata S; Fortin PR; Fitzcharles MA; Starr MR; Joseph L; Watts CS; Gore B; Rosenberg E; Chhem RK; Esdaile JM Medicine (Baltimore) 1997 Mar;76(2):104-17.