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Diffuse Idiopathic Skeletal Hyperostosis (DISH) and a Possible Inflammatory Component

  • Spondyloarthritis (M Khan, Section Editor)
  • Published:
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Abstract

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.

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Authors and Affiliations

  1. Rheumatic Diseases Unit, Ha’Emek MC, Afula, Israel

    Reuven Mader, Amir Bieber & Irina Novofastovski

  2. Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy

    Nicola Pappone & Pasquale Ambrosino

  3. Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Bochum, Germany

    Xenofon Baraliakos & David Kiefer

  4. Department of Radiology, Musculoskeletal imaging Unit, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel

    Iris Eshed

  5. Rheumatology Unit, L. Sacco University Hospital of Milan, Milan, Italy

    Piercarlo Sarzi-Puttini

  6. Rheumatology Unit, University of Messina, Messina, Italy

    Fabiola Atzeni

  7. Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands

    Jorrit-Jan Verlaan

  8. Ben Gurion University of the Negev, Beer-Sheva, Israel

    Dan Buskila

  9. Medicine, Rheumatology, SEEBMO, Hospital de Santo Espirito da ilha Terceira, Universidade do Porto, Angra do Heroismo, Portugal

    Jacome Bruges Armas

  10. Case Western Reserve University, Cleveland, OH, USA

    Muhammad Asim Khan

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  1. Reuven Mader
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Correspondence to Reuven Mader.

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This article is part of the Topical Collection on Spondyloarthritis

Keypoints

• DISH is characterized by new bone formation considered to be a non-inflammatory in nature.

• There is data to support that a local inflammatory condition might also promote new bone formation in DISH.

• Research should also focus on inflammatory basis in DISH due to its possible implications on future treatments.

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Mader, R., Pappone, N., Baraliakos, X. et al. Diffuse Idiopathic Skeletal Hyperostosis (DISH) and a Possible Inflammatory Component. Curr Rheumatol Rep 23, 6 (2021). https://doi.org/10.1007/s11926-020-00972-x

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