Ankylosing hyperostosis in American blacks: A longitudinal study

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We studied 63 consecutive patients with ankylosing hyperostosis to investigate any possible difference in clinical or roentgenographic features between whites and blacks. Our data suggest that (a) the disease may not be less common among blacks, (b) presence of extraspinal hyperostosis in this disease may be more frequent in black patients, and (c) the known male preponderance of the disease among whites may not occur among blacks.

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... The distinction between DISH and AS is not always straight forward and misdiagnosis has been reported [6, 16•, 53]. The disease has male preponderance, and an old study suggested that it may be more common among African Americans than Whites [54]. We did not review this subject, but there is a need to explore any ethnic and racial differences in its prevalence globally and also to study any differences in its clinical manifestations. ...
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Purpose of Review Diffuse Idiopathic Skeletal Hyperostosis (DISH) is considered a metabolic condition, characterized by new bone formation affecting mainly at entheseal sites. Enthesitis and enthesopathies occur not only in the axial skeleton but also at some peripheral sites, and they resemble to some extent the enthesitis that is a cardinal feature in spondyloarthritis (SpA), which is an inflammatory disease. Recent Findings We review the possible non-metabolic mechanism such as inflammation that may also be involved at some stage and help promote new bone formation in DISH. We discuss supporting pathogenic mechanisms for a local inflammation at sites typically affected by this disease, and that is also supported by imaging studies that report some similarities between DISH and SpA. Summary Local inflammation, either primary or secondary to metabolic derangements, may contribute to new bone formation in DISH. This new hypothesis is expected to stimulate further research in both the metabolic and inflammatory pathways in order to better understand the mechanisms that lead to new bone formation. This may lead to development of measures that will help in earlier detection and effective management before damage occurs.
A patient with ankylosing hyperostosis (Forestier's disease) initially diagnosed elsewhere as a case of ankylosing spondylitis with bamboo spine, is presented. The characteristic roentgenographic findings of Forestier's disease in the axial skeleton of this patient are described, including computerized tomography of the lower lumbar spine and sacroiliac joints. Major clinical and radiological distinguishing features of Forestier's disease and ankylosing spondylitis are discussed.
Of the many associations between histocompatibility antigens and human diseases a prominent one is that between HLA-B27 and inflammatory arthropathies. Hypotheses to explain this association include the B27 gene being linked to a specific immune-response gene required for disease expression and the B27 antigen acting via molecular mimicry with a microorganism or as a microorganism receptor. Alternatively, the HLA-B27 gene might be closely related to a gene which influences bone formation. The finding of a significant association between B27 and Forestier's disease, a disease characterised by abundant new bone formation, supports such a hypothesis.
HLA antigens were determined in 50 patients with hyperostotic spondylosis (Forestier's disease), and compared with 1244 normal controls. There was no significant difference in the distribution of HLA B27 between the two groups. However, there was an increased incidence of HLA B8 among the patients with hyperostotic spondylosis (42 per cent), as compared to the normal controls (17.5 per cent). This difference was statistically significant (p less than 0.005). Sixteen of the 50 patients with hyperostotic spondylosis had evidence of diabetes mellitus, 12 of whom also had the HLA B8 antigen. Thus patients with hyperostotic spondylosis have an increased incidence of HLA B8, associated with an increased incidence of diabetes mellitus.
HLA antigens were studied in three different groups of 50 patients each. These included (a) Forestier's disease, (b) ankylosing spondylitis, and (c) polyarthrosis of the hands. HLA typing included 12 specificities from locus A and 15 from locus B, the frequencies being compared to those in 700 normal controls. No significant differences were found in the frequency of distribution between the polyarthrosis patients and the normal population. In patients with Forestier's disease, B5 was increased, but this was not a significant difference. The antigen B27 was present in 94 per cent of patients with ankylosing spondylitis, confirming previous studies.
All known A, B, and C HLA antigens were determined in 50 white patients with vertebral ankylosing hyperostosis. A statistically significant decrease was found for the A9 and A11 specificities. Only three (6%) of the patients possessed the B27 antigen, a frequency which is not different from that of a control population. B27 therefore does not seem to be linked to abundant new bone formation.
The vertebral involvement of DISH is described from an evaluation of 215 cadaveric spines and 100 patients with the disease. Radiographic features include linear new bone formation along the anterolateral aspect of the thoracic spine, a bumpy contour, subjacent radiolucency, and irregular and pointed bony excrescences at the superior and inferior vertebral margins in the cervical and lumbar regions. Pathologic features include focal and diffuse calcification and ossification in the anterior longitudinal ligament, paraspinal connective tissue, and annulus fibrosis, degeneration in the peripheral annulus fibrosis fibers, L-T-, and Y-shaped anterolateral extensions of fibrous tissue, hypervascularity, chronic inflammatory cellular infiltration, and periosteal new bone formation on the anterior surface of the vertebral bodies.
Diffuse idiopathic skeletal hyperostosis
  • D Resnick
  • R F Shapiro
  • K B Weisner
  • D. Resnick
HLA antigens in Forestier's disease, ankylosing spondylitis and polyarthrosis of hands
  • M G Ercilla
  • M A Brancos
  • Y Breyesse
  • M.G. Ercilla