Summary about Disease
Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a condition characterized by the abnormal calcification or hardening of ligaments, primarily in areas where they attach to the spine. It most commonly affects the thoracic (mid-back) region, but can also occur in the neck (cervical) and lower back (lumbar) spine. In some cases, DISH can also affect other joints, such as the shoulders, elbows, hips, and knees. It is not a form of arthritis, but it can cause stiffness, pain, and reduced range of motion.
Symptoms
The symptoms of DISH can vary from person to person, and some individuals may not experience any symptoms at all. Common symptoms include:
Stiffness in the back, particularly in the morning.
Pain in the back, which may be mild or severe.
Reduced range of motion in the spine.
Difficulty swallowing (dysphagia) if the cervical spine is affected due to bone spurs pressing on the esophagus.
Hoarseness if bone spurs press on the larynx.
Pain in other joints, such as the shoulders, hips, or knees.
Bone spurs.
Causes
The exact cause of DISH is unknown, but several factors are believed to contribute to its development:
Age: DISH is more common in older adults, typically over the age of 50.
Diabetes: People with diabetes are more likely to develop DISH.
Other conditions: Conditions such as obesity, gout, and hyperuricemia (high levels of uric acid in the blood) may increase the risk of DISH.
Certain medications: Some medications, such as retinoids (used to treat skin conditions), may be associated with an increased risk of DISH.
Growth factors: Elevated levels of growth factors in the body may play a role in the development of DISH.
Medicine Used
There is no cure for DISH, and treatment focuses on managing symptoms and improving quality of life. Medications used to treat DISH may include:
Pain relievers: Over-the-counter pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), can help relieve mild to moderate pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Prescription-strength NSAIDs can reduce pain and inflammation.
Corticosteroids: In some cases, corticosteroids may be injected into the affected area to reduce inflammation and pain.
Muscle relaxants: These medications can help relieve muscle spasms and stiffness.
Is Communicable
No, DISH is not a communicable disease. It is not caused by an infection and cannot be spread from person to person.
Precautions
While there is no way to completely prevent DISH, certain precautions may help reduce the risk of developing the condition or manage its symptoms:
Manage underlying conditions: Effectively manage conditions such as diabetes, obesity, and gout.
Maintain a healthy weight: Obesity is a risk factor for DISH, so maintaining a healthy weight is important.
Exercise regularly: Regular exercise can help improve flexibility and range of motion, which can help manage stiffness and pain.
Good posture: Practicing good posture can help reduce stress on the spine.
Ergonomics: Ensuring proper ergonomics in your workspace can help prevent strain on the back and neck.
How long does an outbreak last?
DISH is not characterized by "outbreaks" in the way an infectious disease is. It is a chronic, progressive condition. Symptoms may fluctuate in intensity, with periods of increased pain and stiffness followed by periods of relative calm. The condition itself persists indefinitely, though its progression can vary greatly between individuals.
How is it diagnosed?
DISH is typically diagnosed based on a combination of factors, including:
Medical history and physical exam: The doctor will ask about your symptoms and medical history, and perform a physical exam to assess your range of motion and look for signs of stiffness or pain.
X-rays: X-rays are the primary imaging test used to diagnose DISH. They can reveal the characteristic calcification and bone spurs along the spine. The diagnosis requires characteristic flowing calcification along at least four contiguous vertebral bodies.
Other imaging tests: In some cases, other imaging tests, such as CT scans or MRI scans, may be used to further evaluate the condition and rule out other possible causes of your symptoms. These are often needed if neurological symptoms (like numbness or weakness) are present.
Timeline of Symptoms
The timeline of DISH symptoms can vary greatly.
Early Stages: Symptoms may be mild or nonexistent. Some people may experience subtle stiffness, especially in the morning. These symptoms can be easily dismissed as normal aging.
Gradual Progression: Over months to years, stiffness and pain may gradually increase. Range of motion in the affected areas (most commonly the upper back) may decrease. Bone spurs may start to develop, potentially pressing on nearby structures.
Advanced Stages: Pain and stiffness become more pronounced and chronic. Complications can arise, such as difficulty swallowing (dysphagia) or hoarseness if the cervical spine is affected. The condition stabilizes for some; in others, it slowly progresses.
Important Considerations
Individual Variability: The severity and progression of DISH can vary significantly from person to person. Some people may experience mild symptoms that do not significantly impact their quality of life, while others may experience more severe pain and disability.
Differential Diagnosis: It's crucial to rule out other conditions that can cause similar symptoms, such as osteoarthritis, ankylosing spondylitis, and spinal stenosis.
Multidisciplinary Approach: Management of DISH often requires a multidisciplinary approach involving physicians, physical therapists, and other healthcare professionals.
Surgical Intervention: Surgery is rarely needed but may be considered in severe cases where bone spurs are compressing nerves or other structures, causing significant pain or neurological symptoms or when difficulty swallowing becomes severe.
Long-term Management: DISH is a chronic condition that typically requires long-term management to control symptoms and prevent complications.