What is Diffuse Idiopathic Skeletal Hyperostosis (DISH)?

Diffuse idiopathic skeletal hyperostosis, or DISH, is a type of arthritis characterized by excess bone tissue growth into the soft tissues. It causes ligaments and skeletal joints to become hardened and stiff.

"Hyperostosis" describes the process of excessive bone growth. In the disease of DISH, there's deposition of calcium in the soft tissues that are attached to your skeleton. Calcification generally leads to ossification, which means growth of the bone tissue in the soft tissues of your body.

"Diffuse" means that this condition can occur anywhere along your skeleton. However, it usually begins along your spine, especially in the middle (thoracic) portion. "Idiopathic" means that it occurs for unknown reasons.

Diffuse idiopathic skeletal hyperostosis can cause musculoskeletal pain and mobility problems. Ossification may lead to the development of bone spurs, bony outgrowths that can interfere with joint movement.

How common is diffuse idiopathic skeletal hyperostosis (DISH)?

It is typically found in older populations. It affects less than 1% of people before age 40 but up to 40% of individuals over 50. It is twice as common in individuals assigned male at birth (AMAB) than those assigned female (AFAB).

What are diffuse idiopathic skeletal hyperostosis manifestations?

Diffuse idiopathic skeletal hyperostosis leads to general stiffness and pain, back pain, and neck pain. You will notice it much in the morning and when it is cold. Your range of motion will be prominently decreased.

ATTACKING THE MAJOR SKELETON DISH disease usually first targets your axial skeleton and spine. Still, it may often target parts of your peripheral skeleton-your appendages extending from your main trunk. You may develop joint pain or tendonitis in your:

Shoulders.
Hips.
Elbows.
Knees.
Ankles.
Heels.

DISH disease is often symptomless. When it becomes symptomatic, it is typically because it has been going on for a while. That is, the process had progressed far enough to stiffen your soft tissues.

Occasionally, the symptoms begin when the bone overgrowth starts compressing a nearby nerve. This may sometimes cause discomfort as you move in a particular way or touch a particular spot.

Some people with a pinched nerve experience:

Numbness or tingling
Pins and needles
Muscle weakness

If hyperostosis in your neck compresses your esophagus or throat, it may lead to the following:

Hoarseness.
Choking while swallowing.
Obstructive sleep apnea.

What causes diffuse idiopathic skeletal hyperostosis?

Scientists continue to research the factors that lead to the development of DISH syndrome, and they are currently searching for many potential contributing factors. They're not yet certain of the mechanisms, but thus far, some of the known factors include:

Metabolism: There's considerable overlap between DISH and metabolic syndrome, a term used to describe several related conditions that increase your risk for cardiovascular disease. The conditions include diabetes or high insulin levels, high uric acid levels, high cholesterol, and obesity.
Genetics: Most people with the DISH syndrome carry a genetic marker called HLA-B8. That has been associated with many autoimmune diseases, including Type 1 diabetes. Diffuse idiopathic skeletal hyperostosis, however, itself is not considered an autoimmune disorder, but many of those who have the disease suffer from diabetes.
Inflammation: Most importantly, DISH is typically considered a noninflammatory type of arthritis. This means that it is not driven by automatic inflammation, which is characteristic of autoimmune diseases. There could, in any case, be some low-grade involved. Inflammation could be the trigger for the calcification process somehow.
Growth factors: Excessive secretion of growth factors, such as human growth hormone (HGH), insulin, and insulin-like growth factor 1, may result in excessive bone formation with DISH or hyperostosis. Growth factors are proteins and hormones that will teach your body to grow new tissues.

The risk factors for developing DISH disease include obesity, smoking history, male gender and old age.

You are more likely to get this disease known as DISH if:

Above 50 years of age
Were born with male features.
Other types of arthritis
Metabolic syndrome

How severe is DISH?

DISH syndrome is not always the cause of problems for most people. Some will not even feel that it exists. In worst-case scenarios, diffuse idiopathic skeletal hyperostosis can cause some bad complications.

Some of these include:

Compression of the neck: The large bone spurs along your cervical spine could compress your oesophagus or neck and thus swallow, talk or breathe harder more easily, especially in the night. This can cause low blood oxygen levels over time, leading to hypoxia and affecting your heart, which then leads to long-term effects of strain on the heart.
Fractures and instability of the spine: DISH disease gives you a stiff spine, which puts you at greater risk of fractures. Even minor trauma - low-energy impact - might fracture or displace one of your vertebrae. That would do serious damage and make your spine unstable and more vulnerable to further damage.
Compression of the spinal cord: A significant thickening or large bone spurs along your spinal column can, in the worst of cases, compress your spinal cord. This leads to various nerve pain syndromes, such as sciatica, and other nerve symptoms, referred to as myelopathy. In the most severe cases, this could result in paralysis.

How is diffuse idiopathic skeletal hyperostosis diagnosed?

The imaging tests aid in the diagnosis of diffuse idiopathic skeletal hyperostosis. Evidence of the disease should usually appear on routine X-ray or ultrasound examination. A CT scan would be more detailed if necessary.

They have to search for "flowing ossifications." That is a sequence of three or four vertebrae placed in line, with bone overgrowth or hardening of the ligaments that follow along the bone. It looks somewhat as if drips of wax flow from a candle.

If you have symptoms elsewhere, they'll look for signs of the disease elsewhere. Entheses are typically calcified at the sites where joints or ligaments attach to bones elsewhere.

They'll also search for signs that help differentiate DISH disease from similar conditions like ankylosing spondylitis and osteoarthritis. A person sometimes has diffuse idiopathic skeletal hyperostosis and one of these other diseases.

What is the treatment for diffuse idiopathic skeletal hyperostosis?

DISH disease has no known cure, although physical therapy may help improve flexibility and reduce stiffness. A physical therapist may advise a patient to engage in low-impact exercises carried out at home with minimal requirements and treatments.

Medication is an alternative. You may use OTC pain relievers like NSAIDs to control pains and aches. Your doctor will prescribe pain medicines if required. Pain can also be addressed by injecting cortisone shots to specific areas of your body.

Your doctor will monitor your treatment, looking out for fractures and other complications arising from the condition. Doctors can prescribe bisphosphonate medications to prevent or treat fractures.

In cases where bone overgrowth or bone spurs start compressing nerves, new pain or other symptoms can develop. This is when the pressure can be relieved surgically. Surgery may also be necessary to repair any bone fractures that occur.

Can DISH be prevented?

It is not known what stimulates diffuse idiopathic skeletal hyperostosis, so preventive measures against it are not easy to take. However, metabolic factors, including high blood sugar, high triglycerides, and high insulin levels, increase the risk of developing the infection.

The best hope of preventing DISH is treating any underlying metabolic conditions. It may also help prevent DISH disease from worsening once it has started by treating these conditions.

What are the prospects for those afflicted with DISH disease?

Diffuse idiopathic skeletal hyperostosis has a late onset and progresses slowly. It can take 10 years for the process to begin causing symptoms. If it does, starting with a treatment plan early can keep your symptoms under control.

Once DISH becomes very advanced, it can become debilitating and interfere with even day-to-day movements and comfort. Rare complications are possible. If complications occur, surgery can help treat them.

Living With

How should I care for myself with DISH disease?

Like most degenerative arthritides, DISH responds best to regular, low-weight-bearing exercise. Creating a daily routine can help you remain as flexible and strong as possible for as long as possible.

Appointments with your healthcare provider can also track the progression of your condition. This allows them to intervene in time to prevent severe complications before they occur.

Why choose Tender Palm Super-Speciality Hospital for Diffuse Idiopathic Skeletal Hyperostosis (DISH) Treatment in Lucknow, India?

Tender Palm Super-Speciality Hospital offers advanced Diffuse Idiopathic Skeletal Hyperostosis (DISH) treatment in Lucknow, India, at an affordable cost. We have a team of experienced orthopedic specialists and rheumatologists who provide accurate diagnosis with advanced imaging, personalized medical care, and both non-surgical and surgical treatment options. Our Orthopedics and Joint Care team has decades of experience in successfully treating Diffuse Idiopathic Skeletal Hyperostosis (DISH) in Lucknow, India.