Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a disease that results in calcification and bone growth along the ligaments of the spine. The excess bone growth can also occur throughout the body, where tendons and ligaments insert into the bone. The joints and spinal discs remain normal.
Diffuse Idiopathic Skeletal Hyperostosis is most common in older men. It is very rare in people under the age of 40. Certain Native American groups have a higher prevalence of this disease. This suggests a genetic component may be more likely in some populations. In the US, it is more common in white men, compared to other ethnicities.
Diffuse Idiopathic Skeletal Hyperostosis is not an inflammatory disease. It is typically diagnosed on X-ray. Treatment is geared toward controlling symptoms such as pain and stiffness.
Understanding Diffuse Idiopathic Skeletal Hyperostosis
For most patients, pain and stiffness are the most common symptoms of Diffuse Idiopathic Skeletal Hyperostosis. In some cases, a person may have felt stiffness for many years. They assumed this was normal and they tolerated it. In these patients, Diffuse Idiopathic Skeletal Hyperostosis is often diagnosed incidentally through an X-ray done for other purposes.
The pain from Diffuse Idiopathic Skeletal Hyperostosis can be extreme. It may occur in the neck or the upper or lower back. For some, the pain may be worse in the morning, but it doesn’t go away throughout the day. If the neck is involved, bone growth can cause pressure on other body structures. In very rare cases, this may result in difficulty breathing or swallowing.
Patients often experience pain or tenderness throughout other parts of the body, where the tendons or ligaments attach to the bone. Examples are bony growths in the Achilles tendon, the feet, the knee cap or the shoulder joint.
Patients with Diffuse Idiopathic Skeletal Hyperostosis may experience fatigue and difficulty sleeping. They may also suffer from depression.
Diffuse Idiopathic Skeletal Hyperostosis is diagnosed by a thorough assessment and physical examination.
Following the assessment you may be sent for X-rays and blood tests:
X-rays of the spine, hips, knees, ankles and feet are usually the first step in diagnosing Diffuse Idiopathic Skeletal Hyperostosis. An X-ray of the sacroiliac joints (hips or pelvis) may also help in making a diagnosis. Diffuse Idiopathic Skeletal Hyperostosis does not involve some of the areas of this joint that are affected by other diseases.
Your doctor may send you for blood tests to help rule out other conditions. The symptoms of Diffuse Idiopathic Skeletal Hyperostosis can resemble a rheumatic inflammatory disease called Ankylosing Spondylitis.
- A blood test to determine Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) might be done to check for signs of inflammation. These tests are typically normal in someone with Diffuse Idiopathic Skeletal Hyperostosis whereas they may be elevated in a patient with Anklyosing Spondylitis.
- If there is severe degeneration of the spine, the bony growth could be due to inflammation caused by Anklyosing Spondylitis. Another condition called mechanical spondylosis (degenerative disk disease) could be the culprit. There is significant reactive bony growth in cases where a joint is worn out.
The cause of Diffuse Idiopathic Skeletal Hyperostosis is uncertain.
We know that there are too many bone-building cells (called osteoblasts) laying down calcium or “cement” where they shouldn’t be. We don’t know why this calcification occurs.
The role of genetics and the environment is also not clear. Although rare, Diffuse Idiopathic Skeletal Hyperostosis can run in families.
Although you might have been diagnosed with Diffuse Idiopathic Skeletal Hyperostosis, you are not alone. There are effective treatments available to help you cope with the pain. Even if the disease can’t be cured, current treatment options can make living with the condition much more comfortable.
If you have Diffuse Idiopathic Skeletal Hyperostosis or think you might have it, see your family doctor. In many cases your family doctor can help you manage the symptoms.
In some cases, your family doctor might refer you to a rheumatologist. A rheumatologist is a specialist doctor who is an expert in treating arthritis and inflammatory diseases. He or she can also help manage other conditions such as Diffuse Idiopathic Skeletal Hyperostosis.
Here are some other recommendations:
- Learn as much as you can about this disease.
- Attend your family doctor and/or rheumatologist appointments regularly
- Learn about the medications used to treat Diffuse Idiopathic Skeletal Hyperostosis. The RheumInfo website has many resources to help you understand these medications and their impact on your disease
- Learn how to protect your joints and how to use them properly
People with Diffuse Idiopathic Skeletal Hyperostosis can lead active and productive lives with effective treatment. The approach to treating this disease is to address the symptoms. There is no single treatment that can cure Diffuse Idiopathic Skeletal Hyperostosis. The goal of treatment is to help keep the joints moving smoothly to decrease joint pain. You want to keep limber and prevent limitations in mobility and functioning.
Most medications are geared towards pain control. Unfortunately, there are no medications available that have been shown to alter the progression of the disease. No medicine is able to undo or repair the damage caused by calcification once it occurs. However, medications can help make living with Diffuse Idiopathic Skeletal Hyperostosis much more comfortable and help to keep you limber.
Non-prescription analgesic medications such as acetaminophen (Tylenol) help control pain. This is often the first treatment approach. Non-Steroidal Anti-Inflammatory Drugs can also be used to help with the pain and stiffness.
When non-prescription analgesics and Non-Steroidal Anti-Inflammatory Drugs are not enough to control pain caused by Diffuse Idiopathic Skeletal Hyperostosis, stronger medicines called opioids may be used. These should be discussed with your doctor.
While opioids can be very effective at controlling pain, they should be used with caution. These drugs can cause dependence and have been associated with drug abuse. Examples of opioids include codeine, morphine, and oxycodone.
In rare cases, some patients benefit from cortisone injections directly into the tendon insertion. This type of treatment can reduce pain and swelling.
Physical therapy and exercise are an important part of the overall treatment plan. The right exercises can actually improve the pain and stiffness in your joints. They can also reduce fatigue and the emotional distress of Diffuse Idiopathic Skeletal Hyperostosis. Physical therapy and exercise can help protect the joints by strengthening the muscles around them. They should be done daily to derive the maximum benefit.
Moderate stretching is important to reduce pain and keep the joints limber. Swimming or water-based therapy can be very helpful for flexibility. Aerobic exercise such as walking or bicycling works your heart, improves endurance and increases your overall fitness. It is also an important part of keeping a healthy weight. A trained arthritis physiotherapist can help design an exercise program tailored to you and your needs.
It’s important to protect your joints from further damage. Learn your limitations and recognize activities that cause pain and do what you can to avoid them. Also learn how to use your joints properly. A trained arthritis physiotherapist or occupational therapist can help you align your joints properly. This can go a long way to reduce the stress on your joints.
Read these useful articles on exercising with arthritis – many of the tips can also be applied to people with other kinds of conditions such as Diffuse Idiopathic Skeletal Hyperostosis: