Diffuse idiopathic skeletal hyperostosis (DISH) is a bony hardening (calcification) of ligaments in areas where they attach to your spinal column. Also known as Forestier’s disease, diffuse idiopathic skeletal hyperostosis may cause no symptoms and need no treatment. The most typical symptoms are mild to moderate pain and stiffness in your upper back. DISH can also affect your neck and lower back. Some people have DISH in other areas, such as shoulders, elbows, knees and heels.
A non-inflammatory condition, DISH can be progressive. As it aggravates, it can cause serious complications.
You might have no signs or symptoms with DISH. For those who have signs and symptoms, the upper portion of the back (thoracic spine) is most frequently affected. Symptoms and signs might include:
- Stiffness. Stiffness may be most visible in the morning.
- Pain. You may feel pain in your back or in other affected areas, such as your shoulder, elbow, knee or heel.
- Loss of series of motion. You may discover this most when stretching side to side.
- Problem swallowing or a hoarse voice. You might experience these if you have DISH in your neck.
When to see a doctor
Make an appointment with your doctor if you have consistent pain or tightness in any joint or in your back.
It isn’t clear what causes diffuse idiopathic skeletal hyperostosis, however doctors have some concept of what can increase your risk of the condition. Risk factors consist of:
- Sex. Men are more likely to develop DISH.
- Older age. DISH is most typical in older adults, particularly in people older than 50.
- Diabetes and other conditions. People with type 2 diabetes may be more likely to establish DISH than are those who do not have diabetes. Other conditions that might raise insulin levels in your body might likewise increase your risk, consisting of hyperinsulinemia, prediabetes and obesity.
- Certain medications. Long-term use of medications called retinoids, such as isotretinoin (Amnesteem, Claravis, others), which are similar to vitamin A, can increase your risk of diffuse idiopathic skeletal hyperostosis. It isn’t really clear whether high intake of vitamin A increases your risk, nevertheless.
People with DISH are at risk of certain complications, such as:
- Special needs. Loss of variety of movement in the impacted joint can make it hard to use that joint. For example, DISH in your shoulder can make it difficult to use your arm.
- Difficulty swallowing. Bone spurs in the neck can put pressure on your esophagus. The pressure from bone spurs can likewise cause a hoarse voice or sleep apnea, a sleep disorder in which you stop breathing consistently. Rarely, this can become severe and may need surgery to remove the bone spurs.
- Back fracture. DISH can increase your risk of breaking bones in your spine, especially if you have moderate to severe disease. Even minor injuries can cause fractures. Breaks might need surgery to repair.
To figure out whether you have DISH, your doctor may begin with a physical exam of your spine and joints. He or she will push lightly on your spinal column and joints to understanding of abnormalities. Pain from the pressure on your spine may be a clue to the medical diagnosis. DISH may cause pain at the point where the affected tendon or ligament connects to a bone.
Your doctor also will buy imaging tests to help with the medical diagnosis. Tests that may be used include X-rays, CT scans or MRIs.
Treatment for Diffuse Idiopathic Skeletal Hyperostosis
While there’s no treatment for diffuse idiopathic skeletal hyperostosis, there are steps you can require to minimize pain and stiffness. Treatment is likewise focused on keeping the condition from worsening and avoiding complications.
Because of the relationship in between DISH and conditions such as obesity, insulin resistance and type 2 diabetes, dealing with those conditions might slow or halt the progression of DISH.
Treatment for pain
Treatment for pain caused by DISH is similar to that of other joint disorders. Your doctor may suggest acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or other types of strong pain medications. More severe pain can be treated with corticosteroid injections.
Treatment for stiffness
Physical therapy can minimize the tightness associated with DISH. Exercises might likewise increase your variety of motion in your joints. Ask your doctor about particular exercises you can do. She or he may refer you to a physical therapist for additional assistance.
Surgery might be required in uncommon cases when diffuse idiopathic skeletal hyperostosis causes severe complications. People who experience trouble swallowing due to big bone spurs in the neck may need surgery to remove the bone spurs. Surgery may likewise relieve pressure on the spinal cord brought on by diffuse idiopathic skeletal hyperostosis.
To assist you manage pain and tightness and to halt development of the disease, try these self-care measures:
- Exercise regularly. Regular aerobic workout, such as walking or swimming, can increase your endurance, keep your body more active and assist you cope with DISH. Talk with your doctor prior to beginning an exercise program.
- Achieve and maintain a desirable weight. Considering that obesity is associated with DISH, reducing weight may help keep the disease from advancing and lower your risk of complications.
- Apply heat. Use a heating pad on areas of your body that are affected by diffuse idiopathic skeletal hyperostosis to minimize pain. Set the heating pad at a low setting to lower the risk of burns.