Diffuse idiopathic skeletal hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is characterised by the formation of new bone along the anterolateral spinal column.

Consider a diagnosis of DISH if a person aged over 50 years presents with spinal stiffness/decreased range of motion, back pain, stooped posture, and pain and stiffness in other joints. Bear in mind, however, that many patients with DISH are asymptomatic and it is often an incidental finding discovered during routine imaging.

Symptoms are secondary to new bone formation creating an osteophyte (a small bony bridge), which connects one vertebral body to the next. Spine radiography is the investigation of choice for identifying characteristic bone formation.

Management of DISH requires a multidisciplinary approach and may include non-pharmacological approaches (e.g., patient education, self-management, physiotherapy), pharmacological therapies, and surgery.

​DISH is an under-studied non-inflammatory ankylosing condition characterised by the gradual ossification and calcification of ligaments and entheses.[1]Le HV, Wick JB, Van BW, et al. Diffuse idiopathic skeletal hyperostosis of the spine: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. 2021 Dec 15;29(24):1044-51. http://www.ncbi.nlm.nih.gov/pubmed/34559699?tool=bestpractice.com ​ DISH typically affects the axial skeleton, leading to the formation of at least three anterolateral osteophytes (bony bridges or spurs); the thoracic segment of the spine is most commonly affected, although other sections of the spine may also be involved, as may peripheral joints.[1]Le HV, Wick JB, Van BW, et al. Diffuse idiopathic skeletal hyperostosis of the spine: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. 2021 Dec 15;29(24):1044-51. http://www.ncbi.nlm.nih.gov/pubmed/34559699?tool=bestpractice.com [2]Kuperus JS, Mohamed Hoesein FAA, de Jong PA, et al. Diffuse idiopathic skeletal hyperostosis: etiology and clinical relevance. Best Pract Res Clin Rheumatol. 2020 Jun;34(3):101527. https://www.sciencedirect.com/science/article/pii/S1521694220300449 http://www.ncbi.nlm.nih.gov/pubmed/32456997?tool=bestpractice.com [3]Mader R, Baraliakos X, Eshed I, et al. Imaging of diffuse idiopathic skeletal hyperostosis (DISH). RMD Open. 2020 Feb;6(1):e001151. [Erratum in: RMD Open. 2020 Mar;6(1):e001151corr1.] https://rmdopen.bmj.com/content/6/1/e001151 http://www.ncbi.nlm.nih.gov/pubmed/32111653?tool=bestpractice.com ​​​​