Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) has been associated with various metabolic disorders considered to be cardiovascular risk factors such as obesity, diabetes mellitus, hyperinsulinemia, and hyperlipidemia. To evaluate morbidity and mortality of hospitalized patients with DISH admitted to the department of medicine. One hundred patients from a cohort of 1020 consecutive patients, aged 45 years and more, admitted to the department of medicine were diagnosed as suffering from DISH. Another group of 100 patients, age- and gender matched, admitted without DISH, served as controls. Clinical and demographic characteristics, diagnoses on admission, previous chronic diseases, chronic medical therapy, laboratory tests, and the rates of in-hospital mortality and readmissions within 1 month of discharge were collected from the hospital database, for the two groups. Uncompensated or paroxysmal atrial fibrillation was more often encountered on admission in patients with DISH (p=0.038). Patients with DISH were more likely to suffer from elevated body mass index, arterial hypertension, diabetes mellitus, and previous cerebral vascular accidents, although the differences did not reach statistical significance. However, significantly more patients had an electrocardiographic evidence of left ventricular hypertrophy (p=0.03). The mortality rate was similar between the two groups. The lack of significant associations for cardiovascular risk factors such as diabetes mellitus, hypertension, and high BMI should be interpreted cautiously considering the characteristics of the control group. Identification of comorbid conditions and proper therapeutic interventions may prove useful in reducing the morbidity and mortality associated with this disorder.
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References
Forestier J, Rotes-Querol J (1950) Senile ankylosing hyperostosis of the spine. Ann Rheum Dis 9:321–330
Resnick D, Niwayama G (1976) Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 119:559–568
Resnick D, Niwayama G (1988) Diagnosis of bone and joint disorders, 2nd edn. Saunders, Philadelphia, pp 1563–1615
Littlejohn GO, Smythe HA (1981) Marked hyperinsulinemia after glucose challenge in patients with diffuse idiopathic skeletal hyperostosis. J Rheumatol 8:965–968
Littlejohn GO, Hall S (1982) Diffuse idiopathic skeletal hyperostosis and new bone formation in male gouty subjects. A radiologic study. Rheumatol Int 2:83–86
Vezyroglu G, Mitropoulos A, Kyriazis N, Antoniadis C (1996) A metabolic syndrome in diffuse idiopathic skeletal hyperostos: a controlled study. J Rheumatol 23:672–676
Dougados M, Leporho MA, Esmilaire L et al. (1988) Taux plasmatiques des vitamines A et E au cours de la maladie hyperostosique, la spondyloarthrite ankylosante, et la polyarthrite rheumatoide. Rev Rhum Mal Osteoartic 55:251–254
Mata S, Hill RO, Joseph L, Kaplan P et al. (1993) Chest radiographs as a screening tool for diffuse idiopathic skeletal hyperostosis. J Rheumatol 20:1905–1910
Mader R Diffuse idiopathic skeletal hyperostosis (DISH): a distinct clinical entity. IMAJ
Julkunen H, Heinonen OP, Knekt P, Maatela J (1975) The epidemiology of hyperostosis of the spine together with its symptoms and related mortality in a general population. Scand J Rheumatol 4:23–27
Weinfeld RM, Olson PN, Maki DD, Griffiths HJ (1997) The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skeletal Radiol 26:222–225
Bloom RA (1984) The prevalence of ankylosing hyperostosis in a Jerusalem population—with description of a method of grading the extent of the disease. Scand J Rheumatol 13:181–189
Littlejohn GO (1985) Insulin and new bone formation in diffuse idiopathic skeletal hyperostosis. Clin Rheumatol 4:294–300
El Miedany YM, Wassif G, el Baddini M (2000) Diffuse idiopathic skeletal hyperostosis (DISH): Is it of vascular etiology? Clin Exp Rheumatol 18:193–200
Forestier J, Lagier R (1971) Ankylosing hyperostosis of the spine. Clin Orthop 74:65–83
Mata S, Fortin PR, Fitzcharles MA et al. (1997) A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status. Medicine 76:104–117
Girolamo M di (1991) Cellular, metabolic and clinical consequences of adipose mass enlargement in obesity. Nutrition 7:287–289
Smythe HA (1987) Osteoarthritis, insulin and bone density. J Rheumatol 13 (Suppl): 91–93
Silveri F, Brecciaroli D, Argentati F, Cervini C (1994) Serum levels of insulin in overweight patients with osteoarthritis of the knee. J Rheumatol 21:1899–1902
Charles WD, Betty B, Moskowitz RW (1994) Growth promoting peptides in osteoarthritis and diffuse idiopathic skeletal hyperostosis-insulin, insulin-like growth factor-I, growth hormone. J Rheumatol 21:1725–1730
Lakka HM, Lakka TA, Tuomilehto J et al. (2000) Hyperinsulinemia and the risk of cardiovascular death and acute coronary and cerebrovascular events in men: the Kuopio Ischemic heart Disease Risk Factor Study. Arch Intern Med 160:1160–1168
Pyorala M, Miettinen H, Laakso M, Pyorala K (2000) Plasma insulin and all-causes, cardiovascular, and noncardiovascular mortality: the 22 year follow-up results of Helsinki Policemen Study. Diabetes Care 23:1097–1102
Chu NF, Spiegelman D, Hotamisligil GS et al. (2001) Plasma insulin, leptin, and soluble TNF receptors levels in relation to obesity related atherogenic and thrombogenic cardiovascular disease risk factors among men. Atherosclerosis 157:495–503
Lithell HOL (1991) Effect of antihypertensive drugs on insulin, glucose, and lipid metabolism. Diabetes Care 14:203–209
Julkunen H, Aromaa A, Knekt P (1981) Diffuse idiopathic skeletal hyperostosis (DISH) and spondylosis deformans as predictors of cardiovascular disease and cancer. Scand J Rheumatol 10:241–248
Kannel WB, Abbott RD, Savage DD, McNamara PM (1982) Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med 306:1018–1022
Vaziri SM, Larson MG, Benjamin EJ, Levy D (1994) Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation 89:724–730
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Mader, R., Dubenski, N. & lavi, I. Morbidity and mortality of hospitalized patients with diffuse idiopathic skeletal hyperostosis. Rheumatol Int 26, 132–136 (2005). https://doi.org/10.1007/s00296-004-0529-y
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DOI: https://doi.org/10.1007/s00296-004-0529-y