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.
The spine, or vertebral column, is made up of bones that stack on top of one another. These bones are calledvertebrae. There are five sections of the spine. At the top is the neck, or cervical spine, which connects with the skull. Below the neck is the thoracic spine or mid-back, which has the ribs attached. The ribs form the chest. Below the thoracic spine is the lumbar spine or low back. The lumbar spine attaches to the sacrum which is part of the pelvis. The last section of the spine is the coccyx, also know as the tail bone.
There are ligaments that help stabilized the spine. The ligament along the front of the spine is called the anterior longitudinal ligament. There is another ligament that attaches to the back of the spine called the posterior longitudinal ligament. These are the spinal ligaments that can turn into bone in Diffuse Idiopathic Skeletal Hyperostosis (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.
DISH can occur with other types of arthritis, such as osteoarthritis, and can also sometimes be confused with ankylosing spondylitis because they both affect the spine and entheses.
Who is at risk?
Diffuse Idiopathic Skeletal Hyperostosis generally occurs in people between the ages of 50 and 60. It appears more often in men than women. While the cause is unknown, there seems to be a connection with having diabetes, high blood pressure, coronary artery disease, and being over weight.
Some researchers feel that the extra bone is made because of extra blood supply near the spine. Growth factors that effect the formation of calcium likely play a role.
Symptoms
- Ysphagia (caused by compression of osteophytes) – Dysphagia is often related to DISH. It can Occur because of mechanical obstruction or impingment of the osteophytes at the larynx or pharynx.
- Oesophagal obstruction
- Hoarseness
- Cervical myelopathy
- Atlantoaxial subluxation
- Spinal stenosis
- Ossification of the posterior longitudinal ligament
- Spinal cord injury
- Dyspnea
- Foreign body sensation
- Neurologic manifestations duo to compression of the spinal cord
- Hypercholesterinemia (resulting in cardiovacular comorbidities)
- Peripheral joint affection
Treatment
Medications – While there is no cure for DISH, there are treatments that can help the symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) may help manage pain or tendonitis-like inflammation. Tylenol® which is also called acetaminophenmay also help relieve pain. More severe pain may be treated with corticosteroid injections.
Surgery – Rarely is surgery necessary. However, if the extra bone growth compresses the spinal cord or nerve roots, surgery may be needed. Surgery is done to relieve pressure on the spinal cord or nerve roots. Surgery to take out the extra bone growth (spurs) in the neck may help with symptoms of difficulty swallowing.
Physical therapy may also be recommended for stiffness.
Heat Therapy stimulates the widening of blood vessels to promote increased blood to a specific area. Hot and cold therapy is usually done in combination. This way it allows for the activation of the blood flow by bringing circulation to an inflamed and painful area with heat and sends it out of the blood with cold. When done in office it is usually ten minutes hot then ten cold and ten hot again.
Acupuncture has also been used to decrease muscle tension to provide pain relief. It has been used especially when DISH has affected the neck area causing cervical muscle strain. Many studies done were insufficient for any conclusions to be determined. Some patients have noted significant pain relief.
Cryotherapy (Ice Therapy) – This may be used in order to activate the narrowing of blood vessels in order to slow down circulation in a specific area.
Magnesium – Healthy cells contain high levels of magnesium and lower levels of calcium, so the calcium deposits are likely a result of an imbalance.
Reference –
http://www.physio-pedia.com/Forestier_Disease
http://www.ajronline.org/doi/full/10.2214/AJR.07.7102
http://patient.info/doctor/diffuse-idiopathic-skeletal-hyperostosis
http://www.emedicinehealth.com/diffuse_idiopathic_skeletal_hyperostosis_dish/article_em.htm
http://www.orthobullets.com/spine/2045/dish-diffuse-idiopathic-skeletal-hyperostosis