WHAT IS DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH)?
DISH (sometimes called Forestier's disease) is considered a form of degenerative arthritis and is characterized by excessive bone growth along the sides of the vertebrae of the spine. It is also associated with inflammation and calcification (bone growth) at other areas of the body where tendons and ligaments attach to bone, such as at the elbow, knee and the heel of the foot. These can lead to bone spurs. Heel spurs, for example, are common among people with DISH.
HOW COMMON IS DISH?
DISH is thought to be the second most common form of arthritis after osteoarthritis. It affects between six and 12 percent of North Americans, almost always occurring among people older than 50. Unlike most types of arthritis, DISH occurs more often among men (65%) than women (35 %), and affects 28 percent of men over the age of 80.
WHAT ARE THE WARNING SIGNS OF DISH?
Symptoms of DISH include intermittent back pain and particularly stiffness of the back, especially in the area from below the neck to the middle of the back. Stiffness is often worst in the morning and after long periods of sitting. It can also increase with wet weather. Pain is sometimes sharp, especially with certain movements such as twisting or bending. Back pain associated with DISH is often relieved through mild activity.
Some people with DISH may have difficulties with swallowing and moving their necks. And because DISH can affect the points where tendons insert into the arms and legs, some people with DISH experience recurring bouts of what seems like tendonitis in such places as the shoulder, elbow, knee or ankle. This "tendonitis" of course, is due to DISH.
Although the symptoms peculiar to DISH have been noted in medical literature for almost 100 years, the disease has only been recognized as a distinct disorder since 1997. For this reason, many physicians are still unfamiliar with the disease and it is often misdiagnosed.
It is likely that many patients who experience regular back pain may have DISH without knowing it. The disease is usually confirmed through x-rays of the thoracic (upper) spine or chest, which reveal the characteristic bony outgrowths of DISH along the vertebrae.
What Causes Dish?
The exact cause of DISH is not known, but people who have been overweight since childhood may be at greater risk of developing the disease.