Diffuse Idiopathic Skeletal Hyperostosis (DISH)

What is DISH?

Diffuse= Spread out, not confined to a single location.

Idiopathic= with a cause that is not known.

Skeletal= to do with the skeleton and surrounding ligaments/tissue.

Hyperostosis= too much growth of bony tissue.

DISH is a form of ARTHRITIS that involves the tendons and ligaments around the spine. Also known as Forestier Syndrome, this condition occurs when the tendons and ligaments become hardened, a process known as calcification. Once the tendons and ligaments harden, parts of this tissue can turn in to bone. This usually occurs at the site where the tissue connects with the bone. As a result a bony spur (outward growth of bone) develops along the edge of the bone.

DISH commonly affects the  upper part of the back and neck, known as the thoracic and cervical spine. DISH can also affect other areas of the body including shoulders, elbows, hands, hips, heels and ankles.

By getting the proper amount of physical activity and strengthening the muscles that support the spine, you can manage your condition.

What are the symptoms?

DISH may or may not cause symptoms, however some examples of symptoms may include:

• Stiffness (most noticeable in the morning or in the evening)
• Pain in the back, especially in the upper back
• Pain in the shoulders, elbows, knees, or heels
• Pain when pressure is applied to the affected area
• Difficulty swallowing or a hoarse voice (if DISH has affected the neck)
• Loss of range of motion (difficulty moving neck or back)
• Tingling, numbness, and/or weakness in the arms or legs

What causes it?

It is unclear as to what may be the cause of DISH. Symptoms usually develop when the bone spurs begin to compress the nearby nerves of the spine.

Although the cause of DISH is unknown, there are certain risk factors that are thought to increase the risk for DISH. These include:

• Are male.
• Are over age 50.
• Have diabetes or another condition that raises your insulin levels, such as pre-diabetes or obesity.
• Have taken the acne medication, isotretinoin (Amnesteem, Claravis and others). Isotretinoin is a synthetic derivative of vitamin A. It’s not clear if natural vitamin A from food or supplements might also be a factor.
• Are a member of the Pima tribe.
• Have unusual spine anatomy.
• Repeatedly move or lift heavy objects, though this connection is controversial.
• None of these factors alone causes DISH. For example, simply taking isotretinoin won’t lead to bone spurs. But if you’re also a man who has diabetes and does heavy physical work, your odds of getting DISH are higher.

How is it diagnosed?

Your doctor will diagnose DISH based on presentation of  your symptoms.

In addition to performing a  physical examination, your doctor may also include the following tests to assist in diagnosis:

• X-Ray: is often performed, which uses invisible electromagentis beams to produce images of internal tissues, bones and organs on to film. Soft tissue structures such as spinal cord, spinal nerves, discs and ligaments, some tumors vascular malformations and cysts are not usually seen on X-Rays. X-Rays provide an overall assessment of the bony anatomy as well as the curvature and alignment of the vertebral column
• Computed tomography scan (CT scan): a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce detailed images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• Magnetic resonance imaging scan (MRI): a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

It is important to note- Blood tests are only helpful to rule out other types of arthritis.

What will happen to me?

With the right treatment plan, most people diagnosed with DISH are able to lead a normal life. In some cases however, problems more serious than neck and back pain can develop.  Bone spurs in the neck can put pressure on your esophagus, making it hard to swallow. They can also cause a hoarse voice or sleep apnea – a problem in which you snore and repeatedly stop breathing during sleep.  DISH can also increase the risk of spinal fractures.

Is there a cure for DISH?

Currently, there is no cure for DISH. While there are treatments that can effectively control symptoms, you should be wary of products or therapies that claim to cure.

What treatments are there for DISH?

Usually treatment involves anti-inflammatory medications, including Non Steroidal Anti-Inflammatory medications  (NSAIDS). Treatment will also typically involve exercise and other physical therapies to help reduce stiffness.

As there is a connection between endocrine disorders such as Diabetes Mellitus and DISH, addressing the underlying condition can also assist in DISH progressing.

In some cases surgery may be required to correct structural problems or issues with nerve compression due to bony spurs. If surgery is required, the surgeon will tailor treatment to each patient and each situation.

Your local Arthritis Office has information on physical activity, healthy eating, medicines and surgery.

What can I do?

1. See your doctor for treatment and advice. Your doctor will help you get the right treatment to manage your symptoms.
2. Learn about DISH and play an active role in your treatment. Not all information you read or hear about is trustworthy so always talk to your doctor or healthcare team about treatments you are thinking about trying. Reliable sources of further information are also listed in the section below. Self management courses aim to help you develop skills to be actively involved in your healthcare. Contact your local Arthritis Office for details of these courses.
3. Learn ways to manage pain.
4. Stay active. Exercise is strongly recommended for people with DISH. It keeps your joints and muscles healthy and flexible and prevents other health problems. You may find it useful to see a physiotherapist or exercise physiologist for advice.
5. Have a healthy diet. There is no diet that will cure DISH, but healthy eating and a diet aimed at maintaining an ideal body weight is recommended.
6. Balance your life. Learn about equipment that make daily tasks easier and how to balance rest and activity.
7. Acknowledge your feelings and seek support. As there is currently no cure for DISH, it is natural to feel scared, frustrated, sad and sometimes angry. Be aware of these feelings and get help if they start affecting your daily life.

Page reviewed and updated 1st May 2023