Ankylosing hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly.

This is a common disease of the spine seen in the elderly. The most striking feature is the exuberant formation of degenerative osteophytes.

Often the condition is asymptomatic but it may present with stiffness and pain.

DISH is diagnosed when ossification of the anterolateral aspect of the anterior longitudinal ligament is present on at least four contiguous spinal levels without involvement of the intervertebral disk space and/or apophyseal (facet) joints

• disease usually affects the thoracic spine
• other possible features include:
  • peripheral joints manifestations especially in the form of hypertrophic osteoarthritis (OA), osteoarthritis involving joints usually not affected by OA such as the elbow and shoulder, and enthesopathies related to joints (i.e. tibial tuberosity, elbow) and in sites unrelated to joints (ie, plantar fascia, iliolumbar ligament

The disease can manifest itself also at extraspinal locations leading to peripheral entheseal ossification and bony spurs

The overall incidence in the general population ranges from 6% to 12%. Among individuals aged 50 or older, DISH affects approximately 25% of males and 15% of females. Prevalence rates increase in patients aged 80 or older, with 28% males and 26% females affected.

Other associations include: (2,3)

• marked increase of the disease with advancing ages
• obesity
• diabetes mellitus

Reference

1. Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013 Dec;9(12):741-50
2. Mader R, Novofestovski I, Adawi M, Lavi I. Metabolic syndrome and cardiovascular risk in patients with diffuse idiopathic skeletal hyperostosis. Semin Arthritis Rheum. 2009 Apr;38(5):361-5.
3. Pariente-Rodrigo E et al. Relationship between diffuse idiopathic skeletal hyperostosis, abdominal aortic calcification and associated metabolic disorders: Data from the Camargo Cohort. Med Clin (Barc). 2017 Sep 08;149(5):196-202.