Back to A-Z

Diffuse idiopathic skeletal hyperostosis (DISH, Forestier's disease)

DISH is frequently described (>10% in >50-year-olds) in older, asymptomatic patients at the axial skeleton as a radiologic incidental finding. Often, the criteria defined by Resnick 1976 are used to diagnose DISH at the spine: "flowing" ossifications anterolaterally over at least four consecutive vertebral bodies, relatively preserved intervertebral space without significant osteochondrosis, no inflammatory changes at the sacroiliac joints. The thoracic spine is where DISH most commonly manifests. DISH is frequently described in axial diagnosis and there are associations with endocrinopathies. We often see asymptomatic axial hyperostosis in metabolic syndrome, for example. The ossifications of e.g. the ligaments can lead axially to movement restrictions and pain, depending on the location also to foraminal or spinal canal compressions. However, it is a systemic disease with exuberant ossifications (hyperostoses) at the attachments of tendons and ligaments also at peripheral joints.As at the axial skeleton, it can be assumed that DISH does not lead to significant symptoms at the peripheral joints - apart from movement restrictions. Therefore, it is important to know the radiological manifestations of DISH and to distinguish them from inflammatory processes with other therapeutic consequences. On the axial skeleton, the differential diagnosis should primarily exclude axial spondyloarthritis or, rarely, SAPHO syndrome. On the hands, other proliferative joint diseases such as psoriatic arthritis or (secondary) osteoarthritis should be considered - among others, CPPD or hemochromatosis should be considered, which was excluded in this patient.







MedicineNet (German)


Previous Next