What is DISH (Diffuse Idiopathic Skeletal Hyperostosis)?
Diffuse Idiopathic Skeletal Hyperostosis is a form of arthritis that is also known as Forestier’s Disease. DISH mostly affects the bones and joints of the spinal column, but this condition has been diagnosed in people in the joints of their upper and lower extremities. Specifically, DISH affects the tendons and ligaments located in and around the spine. In this condition, the tendons and ligaments harden at the point that they attach to your spine. This hardening of the ligaments and tendons is called calcification and leads to the formation of bone spurs at these attachment sites where the disease manifests. If the words of the entire name of this condition are broken down, it describes the causes and symptoms of this disease.
- Diffuse = widespread, does not appear at a single location
- Idiopathic = no known cause
- Skeletal = involving the bones
- Hyperostosis = an overgrowth of bone tissue
DISH is a rare disorder that generally affects individuals over the age of 50 and affects more men than women.
What Causes DISH?
The cause of DISH is ultimately unknown. This is what the word ‘idiopathic’ in the name of the disease refers to. However, the pathological process of the disease is known. This is a build-up of calcium salts that leads to the hardening of tissue and subsequent overgrowth of bony tissue. But it is what causes this to process to occur that is unknown.
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Symptoms of DISH
Symptoms are not always present with this condition. A person may present as asymptomatic when this disease process is going on in their body. If one does experience symptoms, these may include one or all of the following:
- Pain in your spine, particularly the upper back
- Loss of range of motion
- Stiffness: generally worse in the morning and eases as the day goes on
- Hoarseness and difficulty swallowing
- Tingling and numbness in your extremities resulting from the bone spurs compressing nerves in the spine
- In more severe cases, paralysis can result if the spinal cord itself is compressed
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Treatments | How to Treat DISH
There is no cure for Diffuse Idiopathic Skeletal Hyperostosis as the process of calcification of ligaments and tendons and subsequent bone growth cannot be stopped. But it can be managed. Only in severe cases that present with compression of the spinal cord will surgical intervention be recommended. Surgery may also be considered when the disease is affecting your neck causing bone spur formation that affects your swallowing. Surgical removal of these bone spurs may be necessary.
But with conservative treatment, in most cases symptoms can be managed and dysfunction kept to a minimum. These conservative measures are:
- A course of physical therapy that focuses on maintaining flexibility and mobility in general
- Controlling weight and blood sugar: these are both especially important as DISH has an association with both obesity and Diabetes
- Corticosteroid injections and muscle relaxers
- Over the counter pain relievers and NSAIDS (non-steroidal anti-inflammatory drugs) such as Tylenol and Ibuprofen
- Orthotic shoe inserts