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Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms.

Reuven Mader1, Jorrit-Jan Verlaan, Dan Buskila

  • 1Rheumatic Diseases Unit, Ha'Emek Medical Centre, Afula 18101, Israel.

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Summary

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition where ligaments and entheses become calcified. It is most common in older men and is often asymptomatic. However, DISH can cause pain, stiffness, and difficulty swallowing. The causes of DISH are not fully understood. Current diagnostic criteria require advanced stages of ossification, which may delay detection. This review discusses DISH epidemiology, clinical features, and the need for updated diagnostic criteria. It emphasizes the importance of recognizing DISH-related symptoms and improving early diagnosis.

Keywords:
diffuse idiopathic skeletal hyperostosisossification ligamentsentheses calcificationspinal hyperostosis

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Area of Science:

  • Rheumatology and musculoskeletal disorders
  • Geriatric medicine and aging-related conditions
  • Orthopedic pathology

Background:

DISH is a systemic condition involving ligament and entheses calcification, but its causes remain unclear. Prior research has shown that DISH occurs globally across all populations. It is most common in men over 50 years of age. While often asymptomatic, DISH can lead to complications like pain and reduced joint motion. The condition is frequently associated with underlying metabolic disorders. Current diagnostic criteria require advanced ossification stages, which limits early detection. No prior work had resolved the early pathophysiological mechanisms of DISH. That uncertainty drove the need for updated classification criteria. This gap motivated a review of existing literature on DISH epidemiology and clinical features.

Purpose Of The Study:

This review aims to summarize current knowledge on DISH epidemiology, causes, and clinical features. The authors focus on gaps in understanding DISH pathogenesis. They highlight the diagnostic challenges posed by requiring advanced ossification stages. The study also addresses the need for revised diagnostic criteria. It seeks to clarify the relationship between DISH and metabolic diseases. The goal is to inform better identification of early DISH phases. It also aims to improve recognition of DISH-related symptoms. The review provides updated insights into DISH classification and implications.

Main Methods:

The authors conducted a literature review on DISH epidemiology, causes, and clinical features. They analyzed diagnostic criteria currently used for DISH diagnosis. The study evaluated existing classification systems for DISH. It considered limitations in diagnosing early-stage DISH. The authors reviewed clinical manifestations reported in DISH patients. They examined associations between DISH and metabolic disorders. The study also explored the role of ossification in symptom development. It aimed to identify areas for improved diagnostic approaches.

Main Results:

DISH is most prevalent in men over 50 years of age. The condition is associated with metabolic diseases in many cases. Spinal and extraspinal ossifications can cause pain and stiffness. DISH is often asymptomatic but may lead to dysphagia in some patients. The aetiology of DISH remains poorly understood. Current diagnostic criteria require advanced ossification stages. Existing classification systems may miss early DISH phases. The study emphasizes the need for revised diagnostic criteria.

Conclusions:

The authors synthesize evidence on DISH epidemiology, causes, and clinical features. They highlight the limitations of current diagnostic criteria. The review suggests that revised criteria could improve early DISH detection. DISH is frequently linked to metabolic disorders. The study proposes that early diagnosis may improve patient outcomes. It emphasizes the importance of recognizing DISH-related symptoms. The authors suggest that updated classification systems are needed. They conclude that further research is required to clarify DISH pathogenesis.

DISH can cause pain, stiffness, reduced joint motion, and dysphagia in some patients.

Current criteria require advanced ossification stages, which may delay detection.

The condition is often associated with underlying metabolic disorders in affected individuals.

Spinal ossifications may lead to pain and increase the risk of unstable spinal fractures.

Extraspinal ossifications can cause symptoms like pain and reduced range of motion.

The authors suggest modified criteria to enable earlier identification of DISH phases.