Diffuse Idiopathic Skeletal Hyperostosis (DISH) Lecture Notes

Introduction

• Definition: DISH is a type of arthritis characterized by the calcification or hardening of ligaments and connective tissues.
• Common Sites: Mainly affects the spine but can also impact elbows, knees, Achilles tendons, shoulders, hips, ankles, and even the skull.
• Other Name: Known as Forrester's Disease.
• Prevalence: Second most common form of arthritis after osteoarthritis.

Epidemiology

• Age Factor: More prevalent in older individuals; risk increases with age.
• Gender: Twice as common in males compared to females.

Pathophysiology

• Calcification: Hardening occurs where tendons and ligaments connect to bones.
• Bone Spurs: New growths may form due to this hardening.

Causes

• Unclear Etiology: Exact cause unknown.
• Calcium Salt Buildup: In ligaments and tendons provoke new bone growth.

Risk Factors

• Being male
• Age over 50
• Diabetes and conditions that raise insulin levels (e.g., pre-diabetes, hyperinsulinemia)
• Obesity
• Prolonged use of certain medications (e.g., isotretinoin)
• Unusual spine anatomy

Symptoms

• Often asymptomatic until bone spurs compress nerves.
• Possible Symptoms:
  • Pain
  • Stiffness
  • Loss of range of motion
  • Hoarse voice or difficulty swallowing (if neck nerves are compressed)
  • Tingling, numbness, or weakness in legs (usually from lower back nerve compression)

Diagnosis

• Physical Examination: Check spine and joint for abnormalities and range of motion.
• Imaging Tests:
  • X-rays
  • CT Scans
  • MRIs
  • Used to confirm diagnosis and rule out other conditions.

Treatment

• Medications: Corticosteroids, injections, muscle relaxants, over-the-counter pain relievers.
• Physical Therapy: To increase range of motion.
• Surgery: Considered in severe cases (e.g., difficulty swallowing due to neck spurs).
• Home Remedies: Warm compresses to alleviate pain and stiffness.

Conclusion

• Treatments alleviate symptoms but do not stop the hardening or bone growth process.

Additional Information

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