Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
I have just been diagnosed with diffuse idiopathic skeletal hyperostosis (DISH). I'm currently taking antiinflammatory medications. Are there any exercises and/or nutritional suggestions that will also help?
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Melissa Conrad Stöppler, MD
You must consult your doctor for the proper advice for your particular situation. Because DISH can cause loss of range of motion of the spine, exercises that involve stretching the spinal range of motion can often be beneficial. Physical therapists are specifically trained to provide instructions in this area.
DISH is characterized by unique, flowing calcification along the sides of the contiguous vertebrae of the spine.
Symptoms of DISH include intermittent pains and stiffness in the areas of the bony changes of the spine and inflamed tendons.
DISH is diagnosed when the characteristic flowing calcifications are detected with images of the spine, such as in plain film
X-ray methods.
Nonsteroidal anti-inflammatory medications (NSAIDs) can be helpful in both relieving pain and inflammation of DISH.
What is diffuse idiopathic skeletal hyperostosis?
Diffuse idiopathic skeletal hyperostosis (DISH) is considered a form of degenerative arthritis or osteoarthritis. However, DISH is characterized by unique, flowing calcification along the sides of the
contiguous vertebrae of the spine. And, very unlike typical degenerative arthritis, it's also commonly associated with inflammation
(tendinitis) and calcification of tendons at their
attachments points to bone. This can lead to the formation of bone spurs, such as heel spurs. In fact, heel spurs are common among individuals with DISH. DISH has also been called Forestier's disease.
What causes diffuse idiopathic skeletal hyperostosis?
It is not known what causes DISH. DISH is associated with the metabolic syndrome and is more frequent in people with diabetes mellitus.
What are symptoms and signs of diffuse idiopathic skeletal hyperostosis?
Symptoms of DISH include intermittent
pains in the areas of the bony changes of the spine and inflamed
tendons. Stiffness and dull pain, particularly in the upper and
lower back, are common. Sometimes pains in these areas can be sharp with certain body movements, such as twisting or bending over.
DISH is only slowly progressive. Calcifications between the vertebrae occur over many years. This calcification can lead to limitation of motion of the involved areas of the spine.
How is diffuse idiopathic skeletal hyperostosis diagnosed?
DISH is diagnosed when the characteristic flowing calcifications are detected with images of the spine, such as in plain film
X-ray methods.
What is the treatment for diffuse idiopathic skeletal hyperostosis?
Because areas of the spine and
tendons can become inflamed, anti-inflammatory medications
(NSAIDs), such as ibuprofen
(Advil, Motrin) and naproxen
(Aleve), can be helpful in both relieving pain
and inflammation of DISH. It is hoped that by minimizing inflammation in
these areas, further calcification of tendons and ligaments of
the spine leading to calcific bony outgrowths (osteophytes) will
be prevented.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of
cartilage in the joints. Also known as degenerative arthritis. Osteoarthritis
can be caused by aging, heredity, and injury from trauma or disease.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Neck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Bone spurs are pointy outgrowths of bone that develop in areas of inflammation or injury. They commonly occur on the heel and spine and may be the result of reactive arthritis, ankylosing spondylitis, or diffuse idiopathic skeletal hyperostosis. Symptoms include pain, numbness, and tenderness. Treatment focuses on decreasing inflammation and avoiding re-injury.
Heel spurs, pointed, bony outgrowths of the heel, are caused by localized soft tissue inflammation and can be located at the back of the heel or under the heel, beneath the sole of the foot. Plantar fascitis is associated with inflammation caused by heel spurs on the soles of the feet. Both conditions are treated with ice application and anti-inflammatory medications. Orthotics may also provide some relief.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
Cleft palate and cleft lip are facial and oral defects that occur early in pregnancy. A cleft lip is a split of the two sides of the upper lip, and a cleft palate is a split in the roof of the mouth. Cleft lip the fourth most common birth defect in the U.S. Repair of a cleft palate or cleft lip may require multiple surgeries.
Osteoarthritis is a joint inflammation that results
from cartilage degeneration.
Osteoarthritis can be caused by aging, heredity, and
injury from trauma or disease.
The most common symptom of osteoarthritis is pain in
the affected joint(s) after repetitive use.
There is no blood test for the diagnosis of
osteoarthritis.
The goal of treatment in osteoarthritis is to reduce joint
pain and inflammation while improving and maintaining joint function.
What is osteoarthritis?
Osteoarthritis is a form of arthritis that features the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common, affecting over 25 million people in the United Stat...
