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Early stages of diffuse idiopathic skeletal hyperostosis (DISH) and chronic inflammation: the Camargo Cohort Study

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Abstract

Introduction/objectives

DISH has traditionally been considered a non-inflammatory rheumatic disorder. Currently, an inflammatory component has been theorized in the early phases of this condition (EDISH). The study is aimed at investigating a possible relationship between EDISH and chronic inflammation.

Method

Analytical-observational study: participants from the Camargo Cohort Study were enrolled. We collected clinical, radiological, and laboratory data. C-reactive protein (CRP), albumin-to-globulin ratio (AGR), and triglyceride-glucose (TyG) index were assessed. EDISH was defined by Schlapbach’s scale grades I or II. A fuzzy matching with tolerance factor = 0.2 was performed. Subjects without ossification (NDISH), sex- and age-matched with cases (1:4), acted as controls. Definite DISH was an exclusion criterion. Multivariable analyses were performed.

Results

We evaluated 987 persons (mean age 64 ± 8 years; 191 cases with 63.9% women). EDISH subjects presented more frequently obesity, T2DM, MetS, and the lipid pattern [↑TG ↓TC]. TyG index and alkaline phosphatase (ALP) were higher. Trabecular bone score (TBS) was significantly lower (1.310 [0.2] vs. 1.342 [0.1]; p = 0.025). CRP and ALP showed the highest correlation (r = 0.510; p = 0.0001) at lowest TBS level. AGR was lower, and its correlations with ALP (r =  − 0.219; p = 0.0001) and CTX (r =  − 0.153; p = 0.022), were weaker or non-significant in NDISH. After adjustment for potential confounders, estimated CRP means for EDISH and NDISH were 0.52 (95% CI: 0.43–0.62) and 0.41 (95% CI: 0.36–0.46), respectively (p = 0.038).

Conclusions

EDISH was associated with chronic inflammation. Findings revealed an interplay between inflammation, trabecular impairment, and the onset of ossification. Lipid alterations were similar to those observed in chronic-inflammatory diseases.

Key Points

• An inflammatory component has been theorized in early stages of DISH (EDISH)

• In EDISH group compared to non-DISH, we observed significantly higher correlations between biomarkers and some relevant variables. In particular, with alkaline phosphatase (ALP) and with trabecular bone score (TBS)

• EDISH has shown to be associated with chronic inflammation

• The lipid alterations observed in the EDISH group were similar to those observed in chronic-inflammatory diseases

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AGR:

Albumin-to-globulin ratio

ALP:

Alkaline phosphatase

ALVL:

Anterior longitudinal vertebral ligament

BG:

Basal glycemia

CRP:

C-reactive protein

CVD:

Cardiovascular disease

DAMPs:

Damage-associated molecular patterns

DDISH:

Definite DISH

EDISH:

Early DISH

MetS:

Metabolic syndrome

NDISH:

Non-DISH

TBS:

Trabecular bone score

TC:

Total cholesterol

TyG index:

Triglyceride-glucose index

T2DM:

Type 2 diabetes mellitus

WC:

Waist circumference

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Funding

This work was supported by a grant from Instituto de Salud Carlos III (PI21/00532) that could be co-funded by European Union FEDER funds.

Author information

Authors and Affiliations

  1. Camargo Interior Primary Care Center, Servicio Cántabro de Salud. Departamento de Medicina y Psiquiatría (Universidad de Cantabria). Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain

    Emilio Pariente

  2. Hospital at Home Department, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain

    Stefanie F. Pini

  3. Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla. Departamento de Medicina y Psiquiatría (Universidad de Cantabria). Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain

    José M. Olmos & José L. Hernández

  4. Camargo Interior Primary Care Center, Servicio Cántabro de Salud, Santander, Spain

    Patricia Fierro

  5. Servicio de Radiodiagnóstico, Unidad de Radiología Osea, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain

    Rosa Landeras

  6. Camargo Costa Primary Care Center, Servicio Cántabro de Salud, Departamento de Medicina y Psiquiatría (Universidad de Cantabria). Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain

    Carmen Ramos

  7. Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla. Departamento de Medicina y Psiquiatría (Universidad de Cantabria). Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain

    Víctor M. Martínez-Taboada

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  1. Emilio Pariente
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Contributions

Emilio Pariente: conception and design, analysis and interpretation of data, and drafting the manuscript.

Stefanie F. Pini: conception and design, acquisition of data, and drafting the manuscript.

José M. Olmos: analysis and interpretation of data and revising the manuscript critically.

Patricia Fierro: acquisition of data and drafting the manuscript.

Rosa Landeras: analysis and interpretation of data and revising the manuscript critically.

Carmen Ramos: conception and design, drafting the manuscript, and revising the manuscript critically.

Víctor M. Martínez-Taboada: conception and design, analysis and interpretation of data, and revising the manuscript critically.

José L. Hernández: conception and design, analysis and interpretation of data, and revising the manuscript critically.

All of them have approved the final version of the manuscript.

Corresponding author

Correspondence to Emilio Pariente.

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Ethics approval and consent to participate

The postulates of the Declaration of Helsinki were fulfilled. The Camargo Cohort Study was approved by the Clinical Research Ethics Committee of Cantabria (Internal Code 2018.188). All participants gave written informed consent.

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Pariente, E., Pini, S.F., Olmos, J.M. et al. Early stages of diffuse idiopathic skeletal hyperostosis (DISH) and chronic inflammation: the Camargo Cohort Study. Clin Rheumatol 42, 1931–1942 (2023). https://doi.org/10.1007/s10067-023-06574-z

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