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Diffuse idiopathic skeletal hyperostosis (DISH)

A physiotherapist guiding a gentleman stretching

What is diffuse idiopathic skeletal hyperostosis?

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition that causes ligaments to become calcified and hard. It usually affects the ligament around the spine, but it can also affect other areas of the body where ligaments join to bone (entheses). We don’t know what causes DISH. For many people it doesn’t cause any symptoms and it may only be noticed by your doctor by chance when X-rays are taken for another reason. The bones look like they have ‘overgrown’ on X-rays.

DISH can occur with other types of arthritis, such as osteoarthritis, and can also sometimes be confused with ankylosing spondylitis because they both affect the spine and entheses.

Who gets it?

DISH is rare before the age of 40 and occurs more often as people get older. It’s more common in men.

What is the outlook?

When it’s severe, DISH can cause the spine to become stiff and less flexible. Sometimes the calcified ligaments can become so large that they press on structures close by, such as nerves. If the ligaments press on the oesophagus (throat) it can cause difficulty swallowing.

What treatments are available?

At the moment, there aren’t any treatments which are known to stop the calcification of ligaments, so treatments are aimed at improving any symptoms. If DISH is causing pain, your doctor may suggest you take painkillers, or you may be referred to a physiotherapist for advice about the best exercises to do. Surgery around the spine isn’t usually helpful, unless the bony overgrowth is pressing on nerves.


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