Diagnosis

To determine whether you have DISH, your doctor may begin with a physical examination of your spine and joints. He or she will press lightly on your spine and joints to feel for abnormalities. Pain from the pressure on your spine may be a clue to the diagnosis. DISH may cause pain at the point where the affected tendon or ligament attaches to a bone.

Your doctor also will order imaging tests to help with the diagnosis. Tests that may be used include X-rays, CT scans or MRIs.

Treatment

While there's no cure for diffuse idiopathic skeletal hyperostosis, there are steps you can take to reduce pain and stiffness. Treatment is also aimed at keeping the condition from worsening and preventing complications.

Because of the relationship between DISH and conditions such as obesity, insulin resistance and type 2 diabetes, treating those conditions may slow or halt the progression of DISH.

Treatment for pain

Treatment for pain caused by DISH is similar to that of other joint ailments. Your doctor may recommend acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others). More severe pain can be treated with corticosteroid injections.

Treatment for stiffness

Physical therapy can reduce the stiffness associated with DISH. Exercises may also increase your range of motion in your joints. Ask your doctor about specific exercises you can do. He or she may refer you to a physical therapist for further guidance.

Surgery

Surgery may be required in rare cases when diffuse idiopathic skeletal hyperostosis causes severe complications. People who experience difficulty swallowing due to large bone spurs in the neck may need surgery to remove the bone spurs. Surgery may also relieve pressure on the spinal cord caused by diffuse idiopathic skeletal hyperostosis.

Lifestyle and home remedies

To help you manage pain and stiffness and to halt progression of the disease, try these self-care measures:

  • Exercise regularly. Regular aerobic exercise, such as walking or swimming, can increase your endurance, keep your body more nimble and help you cope with DISH. Talk with your doctor before starting an exercise program.
  • Achieve and maintain a desirable weight. Since obesity is associated with DISH, losing weight may help keep the disease from progressing and lower your risk of complications.
  • Apply heat. Use a heating pad on areas of your body that are affected by diffuse idiopathic skeletal hyperostosis to reduce pain. Set the heating pad at a low setting to reduce the risk of burns.

Preparing for your appointment

If you have signs and symptoms common to DISH, make an appointment with your family doctor or a general practitioner. After an initial evaluation, your doctor might refer you to a specialist such as a rheumatologist, physiatrist, orthopedic surgeon or neurologist.

Here's some information to help you get ready for your appointment.

What you can do

  • Write down your symptoms and when they began.
  • Write down key medical information, including other conditions you have as well as the names of all medications, vitamins or supplements you take.
  • Write down possible causes of injury to the affected area.
  • Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For DISH, some basic questions to ask include:

  • What's the most likely cause of my symptoms?
  • Are there other possible causes for my symptoms?
  • What tests do I need?
  • Which treatment do you recommend?
  • What self-care steps can help me manage this condition?
  • Do I need to restrict my activities?
  • How often will you see me for follow-up visits?
  • If the first treatment approach doesn't work, what will you recommend next?
  • I have other health conditions. How can I best manage them together?
  • Are there brochures or other materials I can take? What websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • What are your symptoms, and when did you first notice them?
  • Have your symptoms gotten worse over time?
  • Are your symptoms worse in the morning?
  • Do you have difficulty moving the affected joint?
  • Are you having difficulty swallowing?
  • What, if anything, seems to improve your symptoms?
  • Have you previously taken long-term, prescribed medications, such as for acne or other skin conditions?
Sept. 16, 2015
References
  1. Helfgott SM. Diffuse idiopathic skeletal hyperostosis (DISH). http://www.uptodate.com/home. Accessed Aug. 20, 2015.
  2. Mader R, et al. Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis. Rheumatology. 2009;48:1478.
  3. Terzi R. Extraskeletal symptoms and comorbidities of diffuse idiopathic skeletal hyperostosis. World Journal of Clinical Cases. 2014;9:422.

Diffuse idiopathic skeletal hyperostosis (DISH)