What is Diffuse Idiopathic Skeletal Hyperostosis?

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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 18 January 2019
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Diffuse idiopathic skeletal hyperostosis (DISH) is a form of degenerative arthritis which involves the spine. People with this condition tend to develop pain and stiffness in the spine over time, and may find their range of motion limited as the condition progresses. There are a number of treatment options available to manage diffuse idiopathic skeletal hyperostosis. A rheumatologist, a doctor who specializes in inflammatory processes, is often a good choice of physician to treat this condition.

In patients with diffuse idiopathic skeletal hyperostosis, the attachment points where tendons and ligaments connect with the spine become inflamed. Over time, they harden and stiffen, limiting movement. On x-rays, a distinctive pattern of calcified formations described as “flowing” can be seen on the vertebrae. Diffuse idiopathic skeletal hyperostosis can strike in any area of the spine, although it is especially common in the neck and upper back.


The causes and risk factors for this condition are not well understood. Age appears to play a role, as does sex, with men being more likely to develop DISH. The use of certain medications seems to be linked, and conditions like diabetes can also be a risk factor. In particular, studies have noted that people with a very high body weight are at increased risk of developing diffuse idiopathic skeletal hyperostosis, perhaps because of the added strain placed on the spine. This condition can also occur as a comorbidity linked with another medical issue, in which case it may take some diagnostic legwork to realize that there are two separate problems going on.

This condition was once known as Forestier's Disease, and this outdated term may still be used in some regions. Treatment involves an examination to determine the extent of the damage, and the use of antiinflammatory medications to bring down the inflammation and swelling. If a patient is also experiencing pain, pain management may be provided. Physical therapy and gentle exercise can also help patients retain freedom of movement, although it can be difficult to reverse damage which is already present.

Once diagnosed with diffuse idiopathic skeletal hyperostosis, it is important for patients to monitor their condition for any signs of change. Once the inflammation is under control, patients should pay attention to changes which might signal a return of inflammation or the development of secondary complications. Monitoring can include regular visits to a doctor to discuss the management approach to the disease, along with physical therapy visits, dietary modifications, and other steps to keep the arthritis under control.



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