EULAR rheumatology open · 2025
Differentiation of diffuse idiopathic skeletal hyperostosis (DISH) with back pain from back pain without DISH-clinical hints.
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Bieber Amir, Mader Reuven, Brikman Shay, Kiefer David, Novofastovski Irina, Baraliakos Xenofon
Аннотация
OBJECTIVES: Diffuse idiopathic skeletal hyperostosis (DISH) is characterised by an exuberant new bone formation involving the entire skeleton and predominantly the spine. Clinical manifestations and symptoms that differentiate DISH from other chronic noninflammatory musculoskeletal diseases are still not well-described. This study aimed to compare the clinical presentation of patients diagnosed with back pain and the diagnosis of DISH vs those without DISH.
METHODS: Data on demographics, musculoskeletal symptoms and clinical examinations were retrieved from a database of 92 clinically symptomatic patients previously diagnosed with DISH and 41 patients with back pain, without concomitant DISH (non-DISH group). Differences between those measures were analysed.
RESULTS: Sex and age distributions were comparable between patients DISH and non-DISH. Chest expansion (CE) was smaller in DISH vs non-DISH (2.1 ± 1.2 cm vs 3.3 ± 1.3 cm, P < .001), whereas a cutoff of CE ≤2.5 cm was significantly associated with diagnosis of DISH (71.1% of DISH vs 31.7% of non-DISH patients, P < .001). In addition, occiput-to-wall distance (OW) was also significantly higher in DISH (5.2 ± 3.3) vs non-DISH (3.5 ± 3.7, P < .01). Compared with non-DISH, the odds ratio for being diagnosed with DISH were increased for patients with a combination of body mass index (BMI) <30, type 2 diabetes, CE ≤2.5 cm and OW ≥5 cm was 4.66.
CONCLUSIONS: In comparison to non-DISH patients with back pain, the combination of high BMI, type 2 diabetes mellitus, small CE and high OW are highly suggestive for DISH patients symptomatic for back pain. Future studies of these measures are warranted in larger cohorts of patients and with DISH patients in various levels of evolvement.
METHODS: Data on demographics, musculoskeletal symptoms and clinical examinations were retrieved from a database of 92 clinically symptomatic patients previously diagnosed with DISH and 41 patients with back pain, without concomitant DISH (non-DISH group). Differences between those measures were analysed.
RESULTS: Sex and age distributions were comparable between patients DISH and non-DISH. Chest expansion (CE) was smaller in DISH vs non-DISH (2.1 ± 1.2 cm vs 3.3 ± 1.3 cm, P < .001), whereas a cutoff of CE ≤2.5 cm was significantly associated with diagnosis of DISH (71.1% of DISH vs 31.7% of non-DISH patients, P < .001). In addition, occiput-to-wall distance (OW) was also significantly higher in DISH (5.2 ± 3.3) vs non-DISH (3.5 ± 3.7, P < .01). Compared with non-DISH, the odds ratio for being diagnosed with DISH were increased for patients with a combination of body mass index (BMI) <30, type 2 diabetes, CE ≤2.5 cm and OW ≥5 cm was 4.66.
CONCLUSIONS: In comparison to non-DISH patients with back pain, the combination of high BMI, type 2 diabetes mellitus, small CE and high OW are highly suggestive for DISH patients symptomatic for back pain. Future studies of these measures are warranted in larger cohorts of patients and with DISH patients in various levels of evolvement.