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Rheumatology Advance Access published online on September 25, 2009
Rheumatology, doi:10.1093/rheumatology/kep308
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Review

Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis

Reuven Mader1,2, Piercarlo Sarzi-Puttini3, Fabiola Atzeni3, Ignazio Olivieri4, Nicola Pappone5, Jorrit-Jan Verlaan6 and Dan Buskila7

1Rheumatic Diseases Unit, Ha’Emek Medical Center, Afula, 2Technion Institute of Technology, Haifa, Israel, 3Rheumatology unit, L Sacco University Hospital, Milan, 4Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, 5Rheumatology and Rehabilitaion Research Unit, Telese Terme (BN), Italy, 6Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands and 7Department of Medicine, H. Soroka Medical Center, Beer Sheva, Israel.

Correspondence to: Reuven Mader, Rheumatic Diseases Unit, Ha’Emek Medical Center, Afula 18101, Israel. E-mail: mader_r{at}clalit.org.il


  Abstract

DISH is a condition characterized by calcification and/or ossification of soft tissues, mainly entheses, ligaments and joint capsules. Its prevalence increases with age and, therefore, DISH is a relatively common entity in the elderly. The classical site of involvement is the spinal column with right anterolateral soft tissue ossification being the most characteristic feature. However, DISH is not limited to the spine, and may affect multiple peripheral sites independently. Extraspinal entheseal ossifications are common and observing their isolated presence may lead to the diagnosis of DISH. Furthermore, hypertrophic or atypical OA observed in joints usually not affected by primary OA has frequently been reported in DISH.

Several metabolic derangements and concomitant diseases have been suggested to be associated with DISH including obesity, increased waist circumference, hypertension, dyslipidaemia, diabetes mellitus (DM), hyperuricaemia, metabolic syndrome and an increased risk for cardiovascular diseases. Witnessing the present increase in lifespan, obesity, DM and metabolic syndrome in the Western population, the prevalence of DISH should be expected to rise. In order to increase the awareness for DISH, this review focuses on the extraspinal features of the condition.

KEY WORDS: DISH, Enthesopathy, Osteoarthritis, Calcification, Metabolic syndrome

Submitted 2 June 2009; revised version accepted 19 August 2009.
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