DISH is also known as forestiers disease,senile ankylosing spondylosis.It is anon inflammatory spondyloarthropathy of the spine. It is characterized by spiny ankylosis and enthesopathy. A form of degenerative arthritis characteristically associated with flowing calcification along the sides of the vertebrae of the spine. Abbreviated DISH. DISH commonly includes inflammation (tendonitis) and calcification of the tendons at their points of attachment to bone. Diffuse idiopathic skeletal hyperostosis (DISH or Forestier's disease) is a form of degenerative arthritis.
Symptoms: The upper portion of the back is commonly affected. 1.stiffness 2.pain 3.loss of range of motion 4.difficulty in swallowing or a horse voice.
Etiology: The exact cause is unknown. Mechanical factors, dietary and long term use of some antidepressants may be of significance. The distinctive radiological feature of DISH is the continuous linear calcification along the antero-medial aspect of the thoracic spine. The disease is usually found in people in their 60s and above, and is extremely rare in people in their 40s and 30s. The disease can spread to any joint of the body, affecting the neck, shoulders, ribs, hips, pelvis, knees, ankles, and hands. Although DISH manifests in a similar manner to ankylosing spondylitis, these two are totally separate diseases. Ankylosing spondylitis is a genetic disease with identifiable marks, and affects organs.
Treament: Physiotherapy and Chiropractic manipulative therapy shows beneficial results for decreasing pain and increasing spinal range of motion. As areas of the spine and tendons can become inflamed NSAIDs such as ibuprofen and Naproxen can be helpful in both relieving pain and inflammation associated with DISH. Further calcification of tendons and ligaments of spine leading to bony outgrowth will be prevented.
Pathology: 1.focal and diffuse calcification and ossification of the anterior longitudinal ligament 2.paraspinal connective tissue and annulus fibrosis 3.degeneration in the peripheral annulus fibrosis fibers 4.anterolateral extensions of fibrous tissue 5.hypervascularity 6.chronic inflammatory cellular infiltration 7.periosteal new bone formation on the anterior surface of the vertebral bodies.
Epidemiology: DISH most commonly affects the elderly (especially 6th to 7th decades). Its estimated frequency in the elderly is at -10%