Diffuse idiopathic skeletal hyperostosis may give the typical postural abnormalities of advanced ankylosing spondylitis.

Rheumatology Department of Lucania, San Carlo Hospital, Contrada Macchia Romana, 85100 Potenza, Italy.
Rheumatology (Impact Factor: 4.21). 12/2007; 46(11):1709-11. DOI: 10.1093/rheumatology/kem227
Source: PubMed

ABSTRACT To describe a case-series of patients who presented with the typical postural abnormalities of long-standing advanced ankylosing spondylitis (AS) but were instead found to suffer from diffuse idiopathic skeletal hyperostosis (DISH).
We enrolled consecutive patients who showed postural abnormalities, which at first suggested to us the diagnosis of long-standing advanced AS, although the diagnostic process led us to the correct diagnosis of DISH. Each patient had a complete physical examination and radiographs of the spine and pelvis, and was investigated for HLA-B27 locus typing.
From 15 June 1998 to 15 June 2006, 15 patients with DISH were seen who presented with the typical postural abnormalities of long-standing advanced AS. All patients were males with a median age of 69 yrs (range 51-91). All lacked HLA-B27 and denied personal or family history of spondyloarthritis. All measurements assessing cervical, thoracic and lumbar spinal movement were abnormal.
Patients suffering from DISH can occasionally have severe limitations of spinal mobility, along with postural abnormalities that resemble long-standing advanced AS. Thus, the differential diagnosis between DISH and advanced AS is not limited to the radiological findings and can also extend to the clinical findings in the two diseases, as is highlighted by our report.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective. To revise the definition of DISH and suggest a classification that may better represent our current knowledge of this entity allowing earlier diagnosis.Methods. Seven rheumatologists and an orthopaedic surgeon suggested a list of 63 parameters that might be included in a future classification of DISH. Participants rated their level of agreement with each item, expressed in percentages. In a second session, participants discussed each item again and re-rated all parameters. Thirty items that were granted ≥50% support on average were considered valid for a third round. A questionnaire listing these 30 items was mailed to 39 rheumatologists and orthopaedic surgeons worldwide with a request to answer categorically if they agreed on an item to be included as a criterion for a future classification of DISH. Items were regarded as perfect consensus when at least 95% of the respondents agreed and were regarded as consensus when at least 80% agreed.Results. There was perfect consensus for 2 (6.7%) of the 30 parameters and consensus for another 2 parameters. These items were ossification and bridging osteophytes in each of the three segments of the spine and exuberant bone formation of bone margins.Conclusion. At present there is no agreement about the inclusion of extraspinal, constitutional and metabolic manifestations in a new classification of DISH. Investigators with an interest in this condition should be encouraged to restructure the term DISH in an attempt to establish a more sophisticated definition.
    Rheumatology (Oxford, England) 09/2012; · 4.24 Impact Factor
  • Source
    La Revue du praticien 06/2005; 55(10):1143-9.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES To evaluate clinical signs, describe lesions and differences in the magnetic resonance imaging appearance of spinal new bone formations classified as disseminated idiopathic spinal hyperostosis and/or spondylosis deformans on radiographs and compare degeneration status of the intervertebral discs using the Pfirrmann scale.METHODS Retrospective analysis of 18 dogs presented with spinal disorders using information from radiographic and magnetic resonance imaging examinations.RESULTSAll dogs were found to be affected with both disseminated idiopathic spinal hyperostosis and spondylosis deformans. Neurological signs due to foraminal stenosis associated with disseminated idiopathic spinal hyperostosis were found in two dogs. Spondylosis deformans was associated with foraminal stenosis and/or disc protrusion in 15 cases.The Pfirrmann score on magnetic resonance imaging was significantly higher in spondylosis deformans compared with disseminated idiopathic spinal hyperostosis and signal intensity of new bone due to disseminated idiopathic spinal hyperostosis was significantly higher compared to spondylosis deformans.CLINICAL SIGNIFICANCEDifferences between disseminated idiopathic spinal hyperostosis and spondylosis deformans found on magnetic resonance imaging contribute to an increased differentiation between the two entities. Clinically relevant lesions in association with disseminated idiopathic spinal hyperostosis were rare compared to those seen with spondylosis deformans.
    Journal of Small Animal Practice 03/2014; · 1.18 Impact Factor

Full-text (2 Sources)

Available from
Sep 10, 2014