Summary
Definition
History and exam
Other diagnostic factors
- spinal pain
- stiffness of the spine
- kyphosis
- decreased range of motion
- spinal fracture
- pain, stiffness, and decreased range of motion in other joints
- lumbar radiculopathy
- cervical myelopathy
- dysphagia
- dyspnea
- sleep apnea
- stridor
Risk factors
- age >50 years
- male sex
- obesity
- genetic risk factors
- metabolic disorders
Diagnostic tests
1st tests to order
- spine x-ray
Tests to consider
- CT spine
- peripheral joint x-ray
- MRI spine
- ultrasound
- dual-energy x-ray absorptiometry (DXA)/whole-spine vertebral fracture assessment (VFA)
- quantitative computed tomography (QCT)
- video swallow study
- laryngoscopy and esophagoscopy
- pulmonary function tests
- C-reactive protein
- HLA-B27
- rheumatoid factor
- antinuclear antibodies (ANA)
Emerging tests
- sclerostin
- parathyroid hormone
Treatment algorithm
no fracture present
fracture present
Contributors
Authors
Priyanka Iyer, MBBS, MPH
Assistant Clinical Professor, Medicine
School of Medicine
University of California, Irvine
Irvine
CA
Disclosures
PI declares that she has no competing interests.
Michael H. Weisman, MD
Adjunct Clinical Professor, Medicine - Immunology & Rheumatology
Stanford University School of Medicine
Stanford
CA
Disclosures
MHW declares that he has no competing interests.
Peer reviewers
Nicola Goodson, MB ChB, FRCP, PhD
Consultant Rheumatologist
Liverpool University Hospitals NHS Foundation Trust
Liverpool
UK
Disclosures
NG declares that she has no competing interests.
References
Key articles
Le HV, Wick JB, Van BW, et al. Diffuse idiopathic skeletal hyperostosis of the spine: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. 2021 Dec 15;29(24):1044-51. Abstract
Kuperus JS, Mohamed Hoesein FAA, de Jong PA, et al. Diffuse idiopathic skeletal hyperostosis: etiology and clinical relevance. Best Pract Res Clin Rheumatol. 2020 Jun;34(3):101527.Full text Abstract
Mader R, Verlaan JJ, Eshed I, et al. Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open. 2017;3(1):e000472.Full text Abstract
Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013 Dec;9(12):741-50. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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