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Diffuse idiopathic skeletal hyperostosis: Differentiation from ankylosing spondylitis

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Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) share involvement of the axial skeleton and peripheral entheses. Both diseases produce bone proliferations in the later phases of their course. Although the aspect of these bone proliferations is dissimilar, confusion of radiologic differential diagnosis between the two diseases exists mostly as a consequence of a lack of awareness of their characteristic clinical and radiographic features. The confusion may extend to the clinical field because both advanced DISH and advanced AS may cause the same limitations of spinal mobility and postural abnormalities. However, the radiologic spinal findings are so different that changes due to each disease can be recognized even in patients in whom both diseases occur. This article reviews the clinical and radiologic characteristics that should help clinicians differentiate between the two diseases without much difficulty.

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References and Recommended Reading

  1. Resnick D, Niwayama G: Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 1976, 119:559–568.

    PubMed  CAS  Google Scholar 

  2. Yagan R, Khan MA: Confusion of roentgenographic differential diagnosis in ankylosing hyperostosis (Forestier’s ai]disease) and ankylosing spondylitis. In: Ankylosing Spondylitis and Related Spondyloarthropathies. Spine: State of the Art Review. Edited by Khan MA. Philadelphia: Haley & Belfus; 1990, 4:561–575.

    Google Scholar 

  3. Yagan R, Khan MA: Confusion of roentgenographic differential diagnosis between ankylosing spondylitis (Forestier’s disease) and ankylosing spondylitis. Clin Rheumatol 1983, 2:285–292.

    Article  PubMed  CAS  Google Scholar 

  4. Khan MA: Ankylosing spondylitis or ankylosing hyperostosis. BMJ 1999, 319:eletter. Available at http://bmj.bmjjournals.com/cgi/eletters/319/7203/171#3975. Accessed July 29, 2009.

  5. Olivieri I, D’Angelo S, Cutro MS, et al.: Diffuse idiopathic skeletal hyperostosis may give the typical postural abnormalities of advanced ankylosing spondylitis. Rheumatology 2007, 46:1709–1711.

    Article  PubMed  CAS  Google Scholar 

  6. Forestier J, Rotes-Querol J: Senile ankylosing hyperostosis of the spine. Ann Rheum Dis 1950, 9:321–330.

    Article  PubMed  CAS  Google Scholar 

  7. Utsinger PD, Resnick D, Shapiro R: Diffuse skeletal abnormalities in Forestier disease. Arch Intern Med 1976, 136:763–768.

    Article  PubMed  CAS  Google Scholar 

  8. Kim SK, Choi BR, Kim CG, et al.: The prevalence of diffuse idiopathic skeletal hyperostosis in Korea. J Rheumatol 2004, 31:2032–2035.

    PubMed  Google Scholar 

  9. Weinfeld RM, Olson PN, Maki DD, Griffiths HJ: The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skeletal Radiol 1997, 26:222–225.

    Article  PubMed  CAS  Google Scholar 

  10. Pappone N, Lubrano E, Esposito-del Puente A, et al.: Prevalence of diffuse idiopathic skeletal hyperostosis in a female Italian population. Clin Exp Rheumatol 2005, 23:123–124.

    PubMed  CAS  Google Scholar 

  11. Westerveld LA, van Ufford HM, Verlaan JJ, Oner FC: The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in the Netherlands. J Rheumatol 2008, 35:1635–1638.

    PubMed  Google Scholar 

  12. Kiss C, O’Neill TW, Mituszova M, et al.: The prevalence of diffuse idiopathic skeletal hyperostosis in a population-based study in Hungary. Scand J Rheumatol 2002, 31:226–229.

    Article  PubMed  Google Scholar 

  13. Littlejohn GO: Insulin and new bone formation in diffuse idiopathic skeletal hyperostosis. Clin Rheumatol 1985, 4:294–300.

    Article  PubMed  CAS  Google Scholar 

  14. Vezyroglou G, Mitropoulos A, Antoniadis C: A metabolic syndrome in diffuse idiopathic skeletal hyperostosis: a controlled study. J Rheumatol 1996, 23:672–676.

    PubMed  CAS  Google Scholar 

  15. Kiss C, Slilágyi M, Paksy A, Poór G: Risk factors for diffuse idiopathic skeletal hyperostosis: a case control study. Rheumatology 2002, 41:27–30.

    Article  PubMed  CAS  Google Scholar 

  16. Sarzi-Puttini P, Atzeni F: New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis). Curr Opin Rheumatol 2004, 16:287–292.

    Article  PubMed  CAS  Google Scholar 

  17. Vernon-Roberts B, Pirie CJ, Trenwith V: Pathology of the dorsal spine in ankylosing hyperostosis. Ann Rheum Dis 1974, 33:281–288.

    Article  PubMed  CAS  Google Scholar 

  18. Arlet J, Mazières B: Hyperostotic disease. Rev Med Interne 1985, 553–564.

  19. Barth KM, Nashel DJ, Haber G: Diffuse idiopathic skeletal hyperostosis in a patient with situs inversus. Arthritis Rheum 1983, 26:811–812.

    Article  Google Scholar 

  20. Mituszova M, Molnar E: Another report of diffuse idiopathic skeletal hyperostosis. Arthritis Rheum 1984, 27:1074.

    Article  PubMed  CAS  Google Scholar 

  21. Rucco V, Zucchi A: Ankylosing vertebral hyperostosis and dextrocardia. Apropos of a case. Rev Rhum Mal Osteoartic 1985, 52:649.

    PubMed  CAS  Google Scholar 

  22. Johnsson KE, Petersson H, Wollheim FA, Säveland H: Diffuse idiopathic skeletal hyperostosis (DISH) causing spinal stenosis and sudden paraplegia. J Rheumatol 1983, 10:784–789.

    PubMed  CAS  Google Scholar 

  23. Resnick D, Guerra J Jr, Robinson CA, Vint VC: Association of diffuse idiopathic skeletal hyperostosis (DISH) and calcification and ossification of the posterior longitudinal ligament. AJR 1978, 131:1049–1053.

    PubMed  CAS  Google Scholar 

  24. Yagan R, Khan MA, Bellon EM: Spondylitis and posterior longitudinal ligament ossification in the cervical spine. Arthritis Rheum 1983, 26:226–230.

    Article  PubMed  CAS  Google Scholar 

  25. Olivieri I, Trippi D, Gemignani G, et al.: Ossification of the posterior longitudinal ligament in ankylosing spondylitis. Arthritis Rheum 1988, 31:452.

    Article  PubMed  CAS  Google Scholar 

  26. Olivieri I, Pappone N, Padula A, et al.: Ossification of the posterior longitudinal ligament in one of a pair of identical twins concordant for ankylosing spondylitis. Clin Rheumatol 1994, 13:309–311.

    PubMed  CAS  Google Scholar 

  27. Olivieri I, Fiandra E, Muscat C, et al.: Cervical myelopathy caused by ossification of the posterior longitudinal ligament in ankylosing spondylitis. Arthritis Rheum 1996, 39:2074–2077.

    Article  PubMed  CAS  Google Scholar 

  28. Dihlman W: Diagnostic Radiology of the Sacroiliac Joints. Chicago, IL: Year Book Medical Publishers; 1980:86–103.

    Google Scholar 

  29. Weisz GM, Green L: Progressive sacroiliac obliteration in Forestier’s disease. Int Orthop 1986, 10:47–51.

    Article  PubMed  CAS  Google Scholar 

  30. Yagan R, Khan MA, Marmolya G: Role of abdominal CT, when available in patient’s records, in the evaluation of degenerative changes of the sacroiliac joints. Spine 1987, 12:1045–1051.

    Article  Google Scholar 

  31. Durback MS, Edelstein G, Schumacher HR Jr: Abnormalities of the sacroiliac joints in diffuse idiopathic skeletal hyperostosis: demonstration by computed tomography. J Rheumatol 1988, 15:1506–1511.

    PubMed  CAS  Google Scholar 

  32. Resnick D: Diffuse idiopathic skeletal hyperostosis (DISH). In: Bone and Joint Imaging, edn 2. Edited by Resnick D. Philadelphia: WB Saunders Company; 1996:378–387.

    Google Scholar 

  33. Resnick D, Shaul SR, Robins JM: Diffuse idiopathic skeletal hyperostosis (DISH): Forestier’s disease with extraspinal manifestation:Radiology 1975, 115:513–524.

    PubMed  CAS  Google Scholar 

  34. Mata S, Fortin PR, Fitzcharles MA, et al.: A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status. Medicine 1997, 76:104–117.

    Article  PubMed  CAS  Google Scholar 

  35. Olivieri I, D’Angelo S, Borraccia F, Padula A: Heel enthesopathy of diffuse idiopathic skeletal hyperostosis resembling Achilles enthesitis of spondyloarthritis. J Rheum, in press.

  36. Mader R: Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine. Semin Arthritis Rheum 2002, 32:130–135.

    Article  PubMed  Google Scholar 

  37. Julkunen H, Heinonen OP, Knekt P, Maatela J: The epidemiology of hyperostosis of the spine together with its symptoms and related mortality in a general population. Scand J Rheumatol 1975, 4:23–27.

    Article  PubMed  CAS  Google Scholar 

  38. Utsinger PD: Diffuse idiopathic skeletal hyperostosis. Clin Rheum Dis 1985, 11:325–351.

    PubMed  CAS  Google Scholar 

  39. Mader R: Diffuse idiopathic skeletal hyperostosis: time for a change. J Rheumatol 2008, 35:377–379.

    PubMed  Google Scholar 

  40. Mader R: Diffuse idiopathic skeletal hyperostosis: isolated involvement of cervical spine in a young patients. J Rheumatol 2004, 31:620–621.

    PubMed  Google Scholar 

  41. Mader R: Current therapeutic options in the management of diffuse idiopathic skeletal hyperostosis. Expert Opin Pharmacother 2005, 6:1313–1316.

    Article  PubMed  CAS  Google Scholar 

  42. Khan MA: Ankylosing Spondylitis. New York: Oxford University Press; 2009.

    Google Scholar 

  43. Olivieri I, van Tubergen A, Salvarani C, van der Linden S: Seronegative spondyloarthritides. Best Pract Res Clin Rheumatol 2002, 16:723–739.

    Article  PubMed  Google Scholar 

  44. Akkoc N, Khan MA: Epidemiology of ankylosing spondylitis and related spondyloarthropathies. In: Ankylosing Spondylitis and the Spondyloarthropathies: A Companion to Rheumatology. Edited by Weisman MH, Reveille JD, van der Heijde D. London: Mosby-Elsevier; 2006:117–131.

    Google Scholar 

  45. Braun J, Bollow M, Eggens U, et al.: Use of dynamic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum 1994, 37:1039–1045.

    Article  PubMed  CAS  Google Scholar 

  46. Bennett PH, Wood PHN: Population Studies of the Rheumatic Diseases. Proceeding of the Third International Symposium. Amsterdam: Excerpta Medica Foundation; 1968:456–457.

    Google Scholar 

  47. Olivieri I, Ciancio G, Scarano E, Padula A: The extension of AS “dagger sign“ into the sacrum. J Rheumatol 2000, 27:2944–2945.

    PubMed  CAS  Google Scholar 

  48. McEwen C, DiTata D, Lingg C, et al.: Ankylosing spondylitis and spondylitis accompanying ulcerative colitis, regional enteritis, psoriasis and Reiter’s disease. Arthritis Rheum 1971, 14:291–318.

    Article  PubMed  CAS  Google Scholar 

  49. D’Agostino MA, Olivieri I: Enthesitis. Best Pract Res Clin Rheumatol 2006, 20:473–486.

    Article  PubMed  Google Scholar 

  50. Resnick D, Niwayama G: Entheses and enthesopathy. Anatomical, pathological, and radiological correlation. Radiology 1983, 146:1–9.

    PubMed  CAS  Google Scholar 

  51. Williamson PK, Reginato AJ: Diffuse idiopathic skeletal hyperostosis of the cervical spine in a patient with ankylosing spondylitis. Arthritis Rheum 1984, 27:570–573.

    Article  PubMed  CAS  Google Scholar 

  52. Olivieri I, Trippi D, Gheradi S, Pasero G: Coexistence of ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis: another report. J Rheumatol 1987, 14:1058–1060.

    PubMed  CAS  Google Scholar 

  53. Olivieri I, Vitali C, Gemignani G, et al.: Concomitant ankylosing spondylitis and DISH. J Rheumatol 1989, 16:1170–1172.

    PubMed  CAS  Google Scholar 

  54. Rillo OL, Scheines EJ, Moreno C, et al.: Coexistence of diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis. Clin Rheumatol 1989, 8:499–503.

    Article  PubMed  CAS  Google Scholar 

  55. Troise Rioda W, Ferraccioli GF: DISH and ankylosing spondylitis. Case report and review of the literature. Clin Exp Rheumatol 1990, 8:591–593.

    PubMed  CAS  Google Scholar 

  56. Maertens M, Mielants H, Verstraete K, Veys EM: Simultaneous occurrence of diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis in the same patient. J Rheumatol 1992, 19:1978–1983.

    PubMed  CAS  Google Scholar 

  57. Tishler M, Yaron M: Two cases of diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis. Br J Rheumatol 1992, 31:569–571.

    Article  PubMed  CAS  Google Scholar 

  58. Olivieri I, Oranges GS, Sconosciuto F, et al.: Late onset peripheral seronegative spondyloarthropathy: report of two additional cases. J Rheumatol 1993, 20:390–393.

    PubMed  CAS  Google Scholar 

  59. Moreno AC, Gonzales ML, Duffin M, et al.: Simultaneous occurrence of diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis. Rev Rhum Egl Ed 1996, 63:292–295.

    CAS  Google Scholar 

  60. Kozanoglu E, Guzel R, Guler-Uysal F, Goncu K: Coexistence of diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: a case report. Clin Rheumatol 2002, 21:258–260.

    Article  PubMed  Google Scholar 

  61. Kim TH, Jun JB: Clinical image. Coexistence of diffuse idiopathic skeletal hyperostosis and ossification of the posterior longitudinal ligament of the cervical spine in a patient with ankylosing spondylitis. Arthritis Rheum 2006, 54:2242.

    Article  PubMed  Google Scholar 

  62. Jordana X, Galtés I, Couto AR, et al.: The coexistence of ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis—a postmortem diagnosis. Clin Rheumatol 2009, 28:353–356.

    Article  PubMed  Google Scholar 

  63. Khan MA: HLA-B27 and its subtypes in world populations. Curr Opin Rheumatol 1995, 7:263–269.

    Article  PubMed  CAS  Google Scholar 

  64. Khan MA: HLA-B27 and its pathogenic role. J Clin Rheumatol 2008, 14:50–52.

    Article  PubMed  Google Scholar 

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Olivieri, I., D’Angelo, S., Palazzi, C. et al. Diffuse idiopathic skeletal hyperostosis: Differentiation from ankylosing spondylitis. Curr Rheumatol Rep 11, 321–328 (2009). https://doi.org/10.1007/s11926-009-0046-9

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