Forestier Disease
Original Editors Lisa Pernet
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Search Strategy[edit | edit source]
Databases: Pubmed, web of knowledge
Search terms: forestier disease, diffuse idiopathic skeletal hyperostosis, treatment DISH, physical therapy DISH
Definition/Description[edit | edit source]
Forestier disease or diffuse idiopathic skeletal hyperostosis is a condition characterized by thickening, calcification and ossification of soft tissues, mainly ligaments, joint capsules and insertions of muscles and tendons (entheses). Another aspect of the disease is the formation of large, flowing osteophytes due to abnormal bone growth (Mader R 2005(A1), Sarzi-Puttini P 2004(A1), Mader R 2009(A1)) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
These ossifications are mostly seen in the axial skeleton, of which the thoracic region is the main location (Mader R 2005(A1), Mader R 2002(C)) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Also peripheral entheses may be affected: peripatellar ligaments, Achilles tendon insertion, plantar fascia, shoulders, olecranon and metacarpophalangeal joints (Mader R 2005(A1), Sarzi-Puttini P 2004(A1), Mader R 2009(A1)) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Forestier disease or DISH has also been described by various other names, such as spondylosis hyperostotica, spondylitis ossificans ligamentosa, senile ankylosing hyperostosis and others (Giles LGF 2001) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Epidemiology/Etiology[edit | edit source]
Forestier disease (DISH) is most common in the elderly population (>50 years old) and the prevalence increases with age (Mader R 2005(A1), Sarzi-Puttini P 2004(A1)) [1,4]. Although the etiology of the disease is not fully understood, studies have already shown that the clinical features are related to the formation of new bone. It is assumed that several metabolic factors affect the onset of the disease (Holton KF 2011(B), Mader R 2002(C), Sarzi-Puttini P 2004(A1), Westerveld LA 2009(C)) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Etiologic / Risk factors associated with various metabolic conditions Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title:
(Mader R 2005(A1), Sarzi-Puttini P 2004(A1), Mader R 2009(A1), Westerveld LA 2009(C))
- waist circumference
- BMI / Obesity
- hyperinsulinemia
- diabetes mellitus
- hyperuricemia
- dyslipidemia
- hypertension
- coronary artery disease
- gout
Characteristics/Clinical Presentation[edit | edit source]
DISH is often asymptomatic (Sarzi-Puttini P 2004(A1), Al-Herz A 2008(B)) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, this is why the diagnosis is usually made on the basis of the radiographic images. When the disease becomes symptomatic, the main clinical features are pain, stiffness and decreased mobility (ROM) (Sarzi-Puttini P 2004(A1), Olivieri I 2007(D)) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Possible additional problems/complications can occur when there are calcifications and osteophytes in the cervical and lumbar spine (Mader R 2002(C), Sarzi-Puttini P 2004(A1), Westerveld LA 2009(C)) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title:
- dysphagia (caused by compression of osteophytes)
- oesophagal obstruction
- hoarseness
- cervical myelopathy
- atlantoaxial subluxation
- spinal stenosis
- ossification of the posterior longitudinal ligament
- spinal cord injury
- dyspnea
Differential Diagnosis[edit | edit source]
- Osteoarthritis:
Dish often coexists with osteoarthritis (Mader R 2005(A1), Sarzi-Puttini P 2004(A1), Mader R 2009(A1)) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Although they both occur in the same age group, there are clear differences between the two conditions on which we can make a distinction: - gender: women (OA) – men (DISH)
- affected structure: cartilage (OA) – entheses (DISH)
- different peripheral sites (Mader R 2002(C)) [3]
- Ankylosing spondylitis (Olivieri I 2007(D)) Cite error: Invalid
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Both diseases affect the axial skeleton and peripheral entheses. In both disorders similar postural abnormalities can be found as a result of the decrease in spinal mobility. Differential diagnosis is based on radiological features and clinical signs. An important difference is the age at which the diseases start. Ankylosing spondylitis already starts at an earlier age than DISH.
Diagnostic Procedures[edit | edit source]
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