Diffuse Idiopathic Skeletal Hyperostosis (DISH), also known as Forestier’s disease, is a form of arthritis characterized by abnormal bone growth in the ligaments, tendons, and joints. This excess bone formation, called hyperostosis, often develops along the spine, leading to stiffness, restricted mobility, and the formation of bone spurs. While many people with DISH may not experience significant symptoms, others may face chronic pain and complications affecting their quality of life.
Causes and Risk Factors
The exact cause of DISH remains unclear, though multiple factors appear to contribute. Conditions such as obesity, diabetes, high cholesterol, and metabolic syndrome are commonly associated. Men over 50 are at greater risk, and genetic markers like HLA-B8 may increase susceptibility. Unlike autoimmune arthritis, DISH is not driven by chronic inflammation, but mild inflammatory processes may play a role in calcification.
Symptoms and Complications
DISH commonly presents with stiffness and pain in the back or neck, often worse in the morning or in cold weather. Over time, mobility decreases, and bone spurs may press on nearby nerves, leading to numbness, tingling, weakness, or nerve pain. In severe cases, cervical spine involvement can cause difficulty swallowing, hoarseness, or sleep apnea. The condition also increases vulnerability to spinal fractures, instability, and in rare cases, spinal cord compression, which may lead to myelopathy or paralysis if untreated.
Diagnosis
DISH is usually diagnosed through imaging. X-rays often reveal “flowing ossifications” resembling melted wax along at least four consecutive vertebrae. CT scans provide more detail, especially when symptoms involve nerves or soft tissues. To confirm the diagnosis, physicians distinguish DISH from conditions such as ankylosing spondylitis or osteoarthritis, which may share overlapping symptoms but follow different disease processes.
Management and Treatment
Treatment focuses on relieving symptoms and preventing complications. Physical therapy plays a vital role in improving flexibility, mobility, and overall function. Pain can often be managed with nonsteroidal anti-inflammatory drugs (NSAIDs), cortisone injections, or stronger medications if necessary. Bisphosphonates may be prescribed in cases involving fractures. Surgical intervention is considered when bone spurs compress nerves or vital structures, or when fractures require stabilization.
Diffuse Idiopathic Skeletal Hyperostosis is a progressive condition that may range from mild stiffness to severe disability. Proper management with exercise, medication, and in some cases surgery, can significantly improve quality of life. Early recognition and ongoing care are essential to prevent complications and maintain mobility.
