DISH is name given to a medical condition that refers to calcification and bony hardening of ligament areas that are attached to the spine. It is also given the name of Forestier's disease.

DISH may occur with no symptoms and no treatment is required. Mild to moderate pain and stiffness in upper back are the most commonly experienced symptoms in DISH. Lower back and neck may also get affected with this disease. Some individuals experience this disease in other regions like knees, heels, shoulders and elbows. Worsening of this disease leads to progression of the disease which may result in serious complications.

Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's Disease

Epidemiology of Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's Disease

In United States, approximately 19 percent of men and 4 percent of women get affected with this disease. Men more than 50 years of age usually get affected with this disease. Idiopathic skeletal hyperostosis is very rarely found in individuals younger than 40 years of age.

Causes and Risk Factors of Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's Disease

The exact cause of DISH is unknown. The suspected causes may include :

  • Sex: Men tend to be more prone to DISH when compared to women.
  • Older Age: DISH more often occurs in older adults particularly in individuals more than 50 years of age.
  • Diabetes.
  • Conditions like prediabetes, obesity and hyperinsulinemia.
  • Certain Medications: Prolonged usage of certain medication known as retinoids like isotretinoin may also lead to DISH.

Signs and Symptoms of Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's Disease

Upper thoracic spine is most commonly affected due to DISH though there may be no symptoms in some of the cases. Common signs and symptoms may include :

  • Stiffness in morning time.
  • Pain in back and in other affected regions like knees, heels, elbows and shoulders.
  • Loss of ranges of motion is also experienced during side to side stretches.
  • DISH affecting neck may cause hoarse voice and difficulty in swallowing.

Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's Disease

There is no proper cure available for the treatment of DISH. Therefore the treatment usually concentrates not only on reducing stiffness and pain associated with idiopathic skeletal hyperostosis but also help in preventing complications and controlling the symptoms in order to stop them from worsening. Treating the primary causes such as diabetes and obesity may slow down or stop the progression of DISH.

Medications for Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's Disease

Generally pain associated with idiopathic skeletal hyperostosis is similar to other joint disorders. Recommended medications may include nonsteroidal antiinflammatory medications and acetaminophen like ibuprofen. Corticosteroid injections may be used for treating severe pain.

Physical Therapy for Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's Disease

Physical therapy helps in decreasing stiffness associated with idiopathic skeletal hyperostosis. Range of motion of the joints can be improved with the help of exercises.

Surgery for Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's Disease

Surgery may be performed in very rare cases with severe complications. Large bone spurs present in the neck often result in swallowing difficulties which may be removed by performing surgery. Surgery helps in relieving the pressure on the spinal cord.

Investigations for Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's Disease 

A complete subjective and physical examination of the spine and joints is performed to diagnose idiopathic skeletal hyperostosis.

Other tests for diagnosing idiopathic skeletal hyperostosis may include :

  • X-rays.
  • Computerized tomography (CT).
  • Magnetic resonance imaging (MRI).

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 2, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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