Diffuse Idiopathic Skeletal Hyperostosis (DISH or Forestier's Disease)

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    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.

  • Medical Editor: Catherine Burt Driver, MD
    Catherine Burt Driver, MD

    Catherine Burt Driver, MD

    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.

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.

What is the outlook (prognosis) for patients with diffuse idiopathic skeletal hyperostosis?

DISH often causes no symptoms, and the long-term outlook is generally good. DISH can lead to limitation of range of motion of the spine. There is no associated threat to any internal organs with this disorder. Rarely, large bone spurs can form in front of the spinal vertebrae of the neck. These spurs occasionally interfere with the passage of food through the upper esophagus (swallowing tube).

Medically Reviewed by a Doctor on 11/6/2015

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