Diagnosed with DISH (Diffuse idiopathic skeletal hyperostosis)

Although many of us heard about the DISH, not too many know exactly what we are talking about! Well, it is time to reveal some important facts about this condition. DISH or to be more precise- Diffuse idiopathic skeletal hyperostosis is one specific condition characterized by hardening of tendons and ligaments that commonly affects the spine. The condition is also known as Forestier's disease. Beside the fact that it attacks our spine, we should also know that it can affect different parts of spine:  upper back (thoracic spine), neck (cervical spine) and lower back (lumbar spine).
Of course, it can also attack other parts of our body such as tendons and ligaments in the heels, ankles, knees, hips, shoulders, elbows and hands. It is characteristic that men are more likely than women to develop diffuse idiopathic skeletal hyperostosis, especially as older adults. Although the symptoms similar to DISH have been noted in medical literature for almost 100 years, the disease is has been recognized as a disorder late, in 1997. For this reason, many physicians are still unfamiliar with the disease and it is often misdiagnosed. Treatment isn't necessary in most cases of diffuse idiopathic skeletal hyperostosis, although physical therapy may help! Surgery is sometimes only possible way out!

If we talk about the frequency of this condition, then we should know that, in the US, condition is present in approximately 19% of men and 4% of women older than 50 years. International frequency shows that about 0.16% of white persons suffer from this condition. No matter how symptoms may be expressed, we should be aware of the fact that DISH still appears to be a phenomenon rather than a disease.  

It is reasonable to assume that the symptoms of this condition primary depend of what part of body is affected by diffuse idiopathic skeletal hyperostosis. Like we have already mentioned- most commonly the upper portion of back is affected and in that case- characteristic symptoms may include:

·         Stiffness in the spine is definitely the most characteristic sign of this condition and, according to the great majority of patients; it may be most noticeable in the morning. It can also increase with wet weather.

·         Although not as expressed as stiffness, pain is also a common symptom! When the pain isn't present, it can be aggravated by pressure on spine.  Pain is sometimes sharp, especially with certain movements such as twisting or bending. Back pain associated with DISH is often relieved through mild activity.

·         Of course, with all this stiffness and pain, range of motion in the spine can’t be extremely good. Loss of lateral range of motion may be most noticeable.  

·         Pain and stiffness but in other parts of the body. Most commonly affected regions are ankles, knees, hips, shoulders, elbows and hands. There is no rule, but, these are considered as a milder form of disease!

Most of the people entering the 50s are interested to hear more about possible risk factors for developing diffuse idiopathic skeletal hyperostosis. Although several researches has been conducted in order to find the correct answer on this question- it is still a mystery! How come? Well, the reason is one- it isn't clear what causes diffuse idiopathic skeletal hyperostosis, and that’s why- it is hard to talk about possible risk factors! However, experts suggested several theories and according to the most of them- possible risk factors are: 

·         Some specific medications

Several researches done in the past have shown that some medications such as retinoids- isotretinoin (Accutane, others), that are similar to vitamin A can increase risk of diffuse idiopathic skeletal hyperostosis. How to explain this? Nobody really knows! It is also important to point out that it still isn't clear whether high intake of vitamin A increases risk.

·         Diabetes and similar conditions related to hormone imbalances

There is no doubt- it is proven that people with diabetes are more likely to develop diffuse idiopathic skeletal hyperostosis than are those who don't have diabetes.  

·         Heart disease and high blood pressure

Several researches done in the past have shown that some heard diseases such as coronary artery disease, the most common form of heart disease and high blood pressure also may contribute to risk of diffuse idiopathic skeletal hyperostosis.

 

How is this condition diagnosed? Well, like with any other physical condition- best way to diagnose it is to first do a complete physical examination. Doctor should press lightly on patient’s spine and joints to feel for abnormalities. Of course, if patient complains on pain- doctor will stop pressuring but it could be a clue to the diagnosis.  

·         X ray imaging

Of course, because we talk about condition that attacks bones and tendons, one of the most useful methods of diagnosis should be a spine X-rays. What should be seen on x-ray images!? Well, in the thoracic spine where diffuse idiopathic skeletal hyperostosis is most common, X-rays may show calcification along the vertebrae.  

·         CT and MRI

We should also point out that there are also some other types of imaging, such as computerized tomography (CT) and magnetic resonance imaging (MRI), which not only may be helpful in diagnosing diffuse idiopathic skeletal hyperostosis, but may even show better and more detailed results.  

Unfortunately- first we must point out that still there is no cure for diffuse idiopathic skeletal hyperostosis. Good thing is that in great majority of cases, treatment may not be necessary. This is because the patients learn to live with their disease! They find their own methods of dealing with pain, stiffness and other symptoms of idiopathic skeletal hyperostosis. However, this isn't case with all patients! It is reasonable to assume that if patient experiences more serious symptoms of diffuse idiopathic skeletal hyperostosis, doctor is obligated to recommend treatments to control pain and maintain range of motion in affected joints.

There is nothing so special or smart in this part of the treatment because relieving the pain caused by diffuse idiopathic skeletal hyperostosis is similar to that of other joint ailments. Most commonly prescribed medications are typical pain relievers such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others). In cases of some serious pain problems- sometimes corticosteroid injections may be necessary to relieve it!

It isn't so hard to assume that the simple physical therapy is probably the best way to fight this constant stiffness! Special physical therapy can easily and effectively reduce the stiffness associated with diffuse idiopathic skeletal hyperostosis. Physical specialist should prescribe some special exercises which should increase the range of motion in joints. These exercises should be planned individually, for every patient! 

Like we have already mentioned- the fact is that sometimes symptoms can be relieved without the surgery! Surgery may also be the indication in rare cases when diffuse idiopathic skeletal hyperostosis causes severe complications.  

Unfortunately, there are several possible complications which can occur in people diagnosed with diffuse idiopathic skeletal hyperostosis! Some of the most common complications are:  

·         Severe disability

Like we have already mentioned, a range of motion in the affected joint can be seriously affected! Sometimes the joint can’t be used at all! This could be a big problem especially if we talk about some usually very mobile joint such as shoulder, hip or knee! This can make a person almost 100% immobile!   

·         Difficulty swallowing

One, also very common, unpleasant complication of diffuse idiopathic skeletal hyperostosis is difficulty with swallowing! How come? Well, it is logical to assume that bone spurs associated with diffuse idiopathic skeletal hyperostosis in the neck can put pressure on patient’s esophagus or food pipe, making it difficult to swallow. Beside these swallowing complications, this can also cause some other symptoms such as hoarse voice or difficulty breathing, especially when sleeping!

·         Paralysis

One of the most serious complications of diffuse idiopathic skeletal hyperostosis is possible paralysis! It the condition attacks one special ligament located on the spine- posterior longitudinal ligament- this can press the spinal cord which results in paralysis!