Diffuse Idiopathic Skeletal Hyperostosis

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Diffuse Idiopathic Skeletal Hyperostosis (DISH)/ Forestier’s Disease

Generally considered a ‘radiological’ rather than a ‘clinical’ disorder – as may have no symptoms. Affects up to 10% of population – but has been reported as being as high as 28%. More common in older age groups. M>F.

Have marginal osteophytes - mostly in spine but can affect other sites. Spinal stiffness and middle to low back pain/ache is common. Recurrent enthesitis is common (achilles tendon, tennis elbow, heel spurs). Plantar fascia and peroneus tendons can be ossified . Recurrent symptoms at these sites may occur. No organs are involved unless osteophytes interfere (eg with food passage due to impingement on oesophagus  difficulty swallowing).

Foot x-ray – ossification of entheses are large, well demarcated and multiple. Exostoses on dorsal surface of talus and navicular are common.

High associations with diabetes mellitus (insulin implicated in pathogenesis – due to growth factor like activity of insulin; occurs in up to 20% of those with type 2), obesity, gout and hypertension.

Management:
Weight reduction; symptomatic treatment (eg NSAID’s if entheses inflamed)

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