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    DISH Syndrome
    alan226 posted:
    I have had back pain on and off for 20+ years. Nothing debilitating, more annoying than anything else. Tested positive for HLA-B27 many years ago. The doctor at the time didn't see any other signs of Ankylosing Spondilitis. Forward to 18 months ago when the pain was getting worse. Went to a Orthopedist who took Xrays and MRI on my lower back which showed pretty severe arthritis as well as some narrowing and prescribed non narcotic pain reliever (tramadol) which actually worked pretty well. Back pain started to get a little worse. When to a spine specialist who referred me to rheumatologist . A battery of blood work and Xrays later, as well as a detailed history which included bouts with tendinitis and heel spurring (possible signs of DISH) He is almost sure it is DISH syndrome although he has not completely ruled out AS until he reviews the recent Xrays. He prescribed Tolectin 600 which has helped.
    My questions:

    Is DISH Syndrome a REAL disease/diagnosis?

    Is there ANY difference between regular(?) Osteoarthritis and DISH?

    What is the prognosis? Going to get worse? Debilitating?

    I have HBP, the whole NSAIDS thing is a concern. I am have never smoked, very slightly overweight (5'9", 200 lbs) and am an avid runner?

    bj1208 responded:
    hi alan226 - sorry it's been awhile and no one has responded -

    i did google DISH syndrome - and am attaching a website that describes it;

    i'm also attaching the website from Mayo Clinic for osteoarthritis

    hopefully this will help answer some questions u have -

    take care - joy
    Joe T Minchew, MD responded:

    Unfortunately, DISH is absolutely a real disease/diagnosis. The condition has also gone by the names of Marie-Strumpel arthritis and Forrestier's disease. As you now may know, it is an acronym for Diffuse Idiopathic Skeletal Hyperostosis. In more simple terms, it is a condition in which the body makes widespread (the diffuse part), exuberant extra bone around the spine and joints (bone spurs or osteophytes). The underlying cause is unknown (the idiopathic part). It seems to affect the spine more than other joints and leads to very large, flowing bone spurs that often span from one vertebral bone to the next. This results in stiffness and loss of motion and is definitely associated with back pain. It is definitely different than ankylosis spondylitis (AS) in that the pattern of bone spurs is not the same. Unfortunately the heel pain, spurs and other issues can be associated with both DISH and AS or may be due to degenerative changes if you are a runner, etc. Unfortunately, there is no "cure" for DISH or AS. The focus for you will be to manage the problem with the help of your rheumatologist and PCP. The concerns about NSAIDs are clearly valid but they may be your best option for baseline pain relief. Again, this is an issue to coordinate with your PCP and rheumatologist trying to balance the risks and benefits with respect to pain relief and side effects. The prognosis is that both DISH and AS tend to progress and worsen over time but that does not necessarily mean that your pain will worsen and your function will deteriorate. A good mantra for this problem is to "minimize pain and maximize function" understanding that both of these problems are systemic diseases that can't be completely fixed.

    I hope this helped. Good luck!

    alan226 replied to Joe T Minchew, MD's response:
    Thank you very much for the thorough response. One additional question if I may. From my readings, AS appears to be a more systemic disease and can affect other organs and systems. Whereas DISH is more confined to the joints and ligaments and is more like "regular" Osteoarthritis and it treated more like regular arthritis and doesn't affect other systems/organs. Is this somewhat accurate if not overly simplistic?
    My rheumatologist mentioned the use of a trial of Enbrel, Remicade, Humira or Simponi if I don't respond to NSAIDS. Would this be appropriate for DISH as well as AS?
    Joe T Minchew, MD replied to alan226's response:

    You are correct in your research. While there are some similiarities in how AS and DISH affects the spine, DISH does not usually affect non musculoskeletal tissues. With respect to the use of the anti-tumor necrosis factor antibody treatments, the indications for the use of is certainly expanding to all sorts of inflammatory conditions and I would think that AS falls in that group. However, not being a rheumatologist, I am not familiar with whether it is thought to be efficaciousl for the treatment of DISH.

    Asweet2600 replied to Joe T Minchew, MD's response:
    My neck and spine is fused together and is caused by dish. What else can it affect ? Can I pass it on to my kids? I am also having trouble with my kidney's? Will I get wheel chair bound or just stiff please tell me so I can continue with my life. I am not going to let it stop me if I can
    davedsel57 replied to Asweet2600's response:

    If you read the earlier posts in this thread, you will see links sites that give information regarding DISH Syndrome. One of the prior health experts also replied with good information.

    We are a group of lay people who have experience with back pain. Our assigned health experts no longer reply to posts.

    Your best course of action would be to discuss this with your doctor.
    Click on my user name or avatar picture to read my story.



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