Diffuse Idiopathic Skeletal Hyperostosis

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Diffuse Idiopathic Skeletal Hyperostosis (DISH) has also been called Forestier's disease. It is considered a form of degenerative arthritis. However, DISH is characterized by unique, flowing calcification along the sides of the vertebrae of the spine. And, very unlike typical degenerative arthritis, it's also commonly associated with tendonitis and calcification of tendons at their attachments points to bone. This can lead to the formation of bone spurs, such as heel spurs. In fact, heel spurs are common among individuals with DISH.

The signs and symptoms you experience depend on what part of your body is affected by DISH. The upper portion of your back (thoracic spine) is most commonly affected. Signs and symptoms may include:

  • Stiffness in the spine Stiffness may be most noticeable in the morning.
  • Pain in the spine You may feel pain when someone presses on your spine. Not everyone with DISH in the spine will experience pain.
  • Loss of range of motion in the spine Loss of lateral range of motion may be most noticeable. You flex your spine laterally when you do side stretches, for example.

  • DISH in other parts of your spine or other parts of your body may cause stiffness and pain. Additionally, diffuse idiopathic skeletal hyperostosis in your neck may cause difficulty swallowing or a hoarse voice.

    The exact cause of DISH is not known, but people who have been overweight since childhood may be at greater risk of developing the disease.

    No cure exists for diffuse idiopathic skeletal hyperostosis. In many cases, treatment may not be necessary. However, if you experience symptoms of DISH, your doctor may recommend treatments to control pain and maintain range of motion in your affected joints.

    . . . Treatment for pain Treatment for pain caused by DISH is similar to that of other joint ailments. Your doctor may recommend pain relievers such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others). More severe pain can be treated with corticosteroid injections.

    . . . Treatment for stiffness Physical therapy can reduce the stiffness associated with DISH. Exercises may also increase your range of motion in your joints. Ask your doctor about specific exercises you can do. He or she may refer you to a physical therapist for further guidance.

    . . . Surgery Surgery may be required in rare cases when DISH causes severe complications. People who experience difficulty swallowing due to large bone spurs in the neck may need surgery to remove the bone spurs. Surgery may also relieve pressure on the spinal cord caused by diffuse idiopathic skeletal hyperostosis.

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