Diffuse idiopathic skeletal hyperostosis

Synthesis

Common skeletal disorder characterized by unusual and new bone formation. The new bones are most often formed at the junction of ligaments and tendons (connective tissue connecting the bones) and bones (enthesis), but there is also a generalized hardening of the bones and bone proliferation (hyperostosis). Although these changes occur most often in the spine, DISH can affect almost all parts of the skeleton, including the hips, knees, ankles, feet, shoulders, hands and ribs. Many people with DISH have no symptoms, but in some cases the symptoms worsen over time (progressive). The most common symptoms are pain, stiffness and reduced range of motion in the neck or upper back. DISH is caused by the accumulation of calcium salts in the tendons and ligaments (calcification) and by abnormal new bone growth (ossification), but the reason is unknown. Researchers believe that a combination of mechanical, genetic, environmental and metabolic factors is involved. DISH is more common in people over 50 and in men. Although there is no known cure for DISH, there are treatments that can help control symptoms.

Symptoms

Although diffuse idiopathic skeletal hyperostosis (DISH) does not cause symptoms for everyone, in some people the symptoms of DISH worsen over time (progress) and become severe. The upper back and neck (thoracic and cervical spine) are the most affected areas of the body. However, people with DISH may also have symptoms in other places, such as feet, ankles, knees, hips, shoulders, elbows, hands, ribs, and even the head (skull) . Symptoms vary depending on the affected skeletal areas, but may include:
Stiffness
Pain
Loss of range of motion
Tingling,
Numbness and / or weakness in the legs
Fractures of the spine and increased risk of fracture of other affected bones
Nerves compressed or pinched (radiculopathy)
Compressed spinal cord (myelopathy) may cause partial or complete paralysis of the legs and / or arms (paraparesis, tetraparesis)
Difficulty swallowing (dysphagia)
Rude voice or difficulty speaking (dysphonia)
Sleep Apnea Decreased lung capacity (if DISH affects the ribs)
Difficulty breathing by obstruction of the upper airways

Causes

Forestier's disease is caused by the build-up of calcium salts in the tendons and ligaments (calcification) and by excessive bone growth (ossification and hyperostosis), but the exact reason for this event is not understood despite many research.
Researchers believe that DISH-specific bone formation is due to abnormal growth and activity of bone-forming cells (osteoblasts) in the region where the tendons and ligaments attach to bone (enthesis).
The causes are:
• Mechanical factors, such as the repetitive lifting and moving of heavy objects
• Dietary factors, such as long-term exposure to large amounts of vitamin A
• Medications, such as the long-term use of synthetic vitamin A or retinoid products, most often used to treat severe acne
• Genetic factors, such as genetic predisposition
• Metabolic disorders, such as diabetes mellitus, acromegaly and obesity

Diagnostic

X-rays can confirm the diagnosis. In some cases, a computed tomography (CT) scan and / or magnetic resonance imaging (MRI) may also be prescribed to rule out other diseases that cause the same symptoms. The three types of imaging studies can be used to determine the affected areas that can be spinal but also extra-spinal (shoulders, elbows, knees, heels, metacarpophalangeal).

Treatment

Focused on the signs and symptoms present in each person. For example, the pain caused is often treated with analgesics, such as tramadol (Topalgic, etc.) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Voltarene, Bi-profenid). Severe pain can be treated with corticosteroid injections. Muscle relaxants may also be useful. Physical therapy and / or exercise can reduce stiffness and help increase the range of motion of the joints. Although few studies have focused on surgical indications, it is generally accepted that surgery is indicated in people with severe symptoms (such as airway obstruction and / or dysphagia).


Prognosis

The long-term prospects of people with Forest Disease are generally considered good because they do not lead to a reduction in life span. However, people with DISH are at risk for certain complications, including: chronic pain, disability due to decreased range of motion, difficulty swallowing pressure on the esophagus, making swallowing difficult or breathing during sleep (sleep apnea), paralysis: bone compression on the spinal cord that can lead to loss of sensitivity and motor skills.

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