Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis

Abstract

DISH is a condition characterized by calcification and/or ossification of soft tissues, mainly entheses, ligaments and joint capsules. Its prevalence increases with age and, therefore, DISH is a relatively common entity in the elderly. The classical site of involvement is the spinal column with right anterolateral soft tissue ossification being the most characteristic feature. However, DISH is not limited to the spine, and may affect multiple peripheral sites independently. Extraspinal entheseal ossifications are common and observing their isolated presence may lead to the diagnosis of DISH. Furthermore, hypertrophic or atypical OA observed in joints usually not affected by primary OA has frequently been reported in DISH. Several metabolic derangements and concomitant diseases have been suggested to be associated with DISH including obesity, increased waist circumference, hypertension, dyslipidaemia, diabetes mellitus (DM), hyperuricaemia, metabolic syndrome and an increased risk for cardiovascular diseases. Witnessing the present increase in lifespan, obesity, DM and metabolic syndrome in the Western population, the prevalence of DISH should be expected to rise. In order to increase the awareness for DISH, this review focuses on the extraspinal features of the condition.

Spondyloarthritis and Diffuse Idiopathic Skeletal Hyperostosis: Two Different Diseases That Continue to Intersect

“…In contrast, DISH is a degenerative condition characterized by calcification and ossification of ligaments and entheseal sites in the axial and the peripheral skeleton 6 . Classification criteria for DISH used so far require involvement of the spine 6 although extravertebral bone proliferations are frequent and characteristic and may precede axial changes 7,8 . An international study for the development of new criteria is in progress 8 .…”

Cervical stenosis in spinal cord injury and disorders

“…4,15 Among degenerative causes of CSS, Diffuse Idiopathic Skeletal Hyperostosis (DISH), is associated with underlying medical conditions including diabetes, hypertension and the metabolic syndrome. 16 Additionally, activation of a proinflammatory marker, nuclear factor kappaB, may be involved in the ossification of spinal ligaments. 17 Nuclear factor kappaB is involved in the pathogenesis of a number of diseases including cardiovascular disease 18 cancer 19 and in cell death processes in general.…”

Spinal hyperostosis in humans and companion animals

“…(i) involvement of joints that are often unaffected by primary OA (ii) increased hypertrophic changes compared with primary OA (iii) prominent enthesopathies at various sites adjacent to peripheral joints (iv) calcifications and ossifications of entheses in sites other than joints (Mader et al 2009) …”