Diffuse idiopathic skeletal hyperostosis may give the typical postural abnormalities of advanced ankylosing spondylitis. Rheumatology (Oxford)

Case Western Reserve University, Cleveland, Ohio, United States
Rheumatology (Impact Factor: 4.48). 12/2007; 46(11):1709-11. DOI: 10.1093/rheumatology/kem227
Source: PubMed


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.

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Available from: Salvatore D’Angelo, Sep 10, 2014
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    • "Like DISH, SD is a non-inflammatory disorder, which is not considered to be of great clinical relevance. However, stiffness of the back, lameness, changes in gait and pain have been described and there is a possible association with disc protrusion (Morgan et al. 1967, Morgan et al. 1989, Belanger & Rowe 2001, Carnier et al. 2004; Levine et al. 2006, Olivieri et al. 2007, Westerveld et al. 2009, Verlaan et al. 2011). "
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    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.
    Full-text · Article · Mar 2014 · Journal of Small Animal Practice
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    • "The systemic disease, DISH, affects the axial and appendicular skeleton and results in ossification of soft tissues, including the spinal ventral longitudinal ligament (Fig. 1) and sites of attachment of tendons and capsules to bone (Forestier and Rotes-Querol, 1950; Resnick and Niwayama, 1976). In humans, DISH is associated with symptoms that vary from mild back pain to spinal cord compression or even spinal fractures (Belanger and Rowe, 2001; Callahan and Aguillera, 1993; Olivieri et al., 2007; Sreedharan and Li, 2005). Occasionally, DISH has been described in the veterinary literature (Morgan and Stavenborn, 1991; Woodard et al., 1985). "
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    ABSTRACT: A retrospective radiographic study was performed to investigate the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and spondylosis deformans (spondylosis) in 2041 purebred dogs and to determine association with age, gender and breed. Four cases of DISH provided information on the appearance of canine DISH. The prevalence of DISH and spondylosis was 3.8% (78/2041) and 18.0% (367/2041), respectively. Of dogs with DISH, 67.9% (53/78) also had spondylosis, whereas 14.0% (53/367) of dogs with spondylosis also had DISH. Dogs with DISH and/or spondylosis were significantly older than those without spinal exostosis. The prevalence of DISH and spondylosis was 40.6% (28/69) and 55.1% (38/69), respectively, in Boxer dogs. Nineteen smaller breeds were not affected by DISH, but showed signs of spondylosis; only standard Poodles appeared not to be affected by either disorder. Radiography, computed tomography (CT), magnetic resonance imaging (MRI), and/or histopathology were used to investigate four DISH cases. It was concluded that spondylosis and DISH can co-occur in dogs. DISH has probably been previously under-diagnosed and mistaken for severe spondylosis. The diagnosis can be made using radiography, CT or MRI. On histology, DISH can be distinguished from spondylosis by the location (ventral longitudinal ligament) and extent of new bone formation.
    Full-text · Article · May 2011 · The Veterinary Journal
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    • "DISH is associated with obesity and the incidence increases with body weight in both the genders [18, 20, 21]. DISH often remains asymptomatic but can lead to mild back pain, stiffness and restriction in spinal range of motion [3, 23]. In advanced stages of DISH, multiple level spinal ankylosis may lead to spinal cord compression or result in unstable fractures of the spine, even after trivial trauma, often mimicking clinical features of ankylosing spondylitis [4, 32]. "
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    ABSTRACT: Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic disorder of the axial and peripheral skeleton in humans and has incidentally been described in dogs. The aims of this retrospective radiographic cohort study were to determine the prevalence of DISH in an outpatient population of skeletally mature dogs and to investigate if dogs can be used as an animal model for DISH. The overall prevalence of canine DISH was 3.8% (78/2041). The prevalence of DISH increased with age and was more frequent in male dogs, similar to findings in human studies. In the Boxer breed the prevalence of DISH was 40.6% (28/69). Dog breeds represent closed gene pools with a high degree of familiar relationship and the high prevalence in the Boxer may be indicative of a genetic origin of DISH. It is concluded that the Boxer breed may serve as an animal model for DISH in humans.
    Full-text · Article · Aug 2010 · European Spine Journal
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