DISH Disease

1 What is Diffuse Idiopathic Skeletal Hyperostosis (DISH)?

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a a condition in which the ligaments that attach to the spine become hard (calcify). It is non-inflammatory progressive condition.

Some people with DISH may not have any symptoms and thus do not require treatment. Symptoms, when present, include mild to moderate pain and stiffness of the upper back. DISH can also affect the neck, back, shoulders, elbows, knees and heels. This condition can cause serious complications as it worsens.

2 Symptoms

Signs and symptoms of diffuse idiopathic skeletal hyperostosis (DISH) may include:

  • Stiffness that can be most noticeable in the morning.
  • Pain in the upper part of the back or any other affected area, such as:
    • The shoulder
    • Elbow
    • Knee
    • or Heel
  • Loss of range of motion especially when stretching side to side -Difficulty swallowing or a hoarse voice.

DISH usually affects the upper part of the back (thoracic spine).

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3 Causes

The exact cause of diffuse idiopathic skeletal hyperostosis (DISH) is unknown.

4 Making a Diagnosis

Doctors usually diagnose diffuse idiopathic skeletal hyperostosis (DISH) by a physical examination of the spine and joints. This involves pressing on the spine and joints to feel for abnormalities. If pain is present when pressure is applied on the spine or affected joint, it may be an indication of DISH.

Other tests used include imaging tests such as:

  • X-rays
  • CT scans
  • or MRI's

5 Treatment

There is no cure for diffuse idiopathic skeletal hyperostosis and the treatments are used for managing symptoms of the disease. The treatments that are available are aimed at reducing pain and stiffness, keeping the condition from becoming worse and preventing the development od complications.

Treatments for pain include:

  • Over-the-counter medications including:
    • Acetaminophen (TYlenol)
  • and Non-steroidal Antiinflammatory drugs (NSAIDs) such as:
    • Ibuprofun (Advil, Motrin IB).

Corticosteroid injections are given for more severe pain. Physical therapy can reduce stiffness associated with DISH . Exercises may also increase the range of motion in the affected joints.

Surgery may be required for severe cases where DISH causes severe complications. Surgery may be performed to relieve pressure on the spine and to remove bone spurs which may cause difficulty swallowing.

Treating conditions that increase the risks of developing complications, such as diabetes, obesity and hyperinsulinemia may slow or stop the progression of DISH.

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with diffuse idiopathic skeletal hyperostosis (DISH).

The following can help reduce pain and stiffness and slow the progression of DISH:

  • Regular aerobic exercise, such as walking or swimming.
  • Losing weight since DISH is associated with obesity.
  • Applying heat to the affected joints.

7 Risks and Complications

Factors that may increase the risk of having diffuse idiopathic skeletal hyperostosis (DISH) include:

  • Being male -Being older than 50
  • Having diabetes or other conditions that may increase insulin levels in the body, such as:
  • Long-term use of mediactions known as retinoids, such as isotetinoin (Amnesteem, Claravis), which are similar to vitamin A.

Complications which can develop in people with DISH include:

  • Disability due to loss of range of motion in the affected joint.
  • Difficulty swallowing due to bone spurs in the neck which can put pressure on the esophagus. These bone spurs can also cause a hoarse voice or sleep apnea, a sleeping disorder in which a person stops breathing repeatedly. If this becomes serious, surgery may be required to remove bone spurs.
  • Spinal fractures which may require surgical repair.
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