Diffuse Idiopathic Skeletal Hyperostosis (DISH) and a Possible Inflammatory Component

Reuven Mader, Nicola Pappone, Xenofon Baraliakos, Iris Eshed, Piercarlo Sarzi-Puttini, Fabiola Atzeni, Amir Bieber, Irina Novofastovski, David Kiefer, Jorrit Jan Verlaan, Pasquale Ambrosino, Dan Buskila, Jacome Bruges Armas, Muhammad Asim Khan

    Research output: Contribution to journalReview articlepeer-review

    21 Scopus citations


    Purpose of Review: Diffuse Idiopathic Skeletal Hyperostosis (DISH) is considered a metabolic condition, characterized by new bone formation affecting mainly at entheseal sites. Enthesitis and enthesopathies occur not only in the axial skeleton but also at some peripheral sites, and they resemble to some extent the enthesitis that is a cardinal feature in spondyloarthritis (SpA), which is an inflammatory disease. Recent Findings: We review the possible non-metabolic mechanism such as inflammation that may also be involved at some stage and help promote new bone formation in DISH. We discuss supporting pathogenic mechanisms for a local inflammation at sites typically affected by this disease, and that is also supported by imaging studies that report some similarities between DISH and SpA. Summary: Local inflammation, either primary or secondary to metabolic derangements, may contribute to new bone formation in DISH. This new hypothesis is expected to stimulate further research in both the metabolic and inflammatory pathways in order to better understand the mechanisms that lead to new bone formation. This may lead to development of measures that will help in earlier detection and effective management before damage occurs.

    Original languageEnglish
    Article number6
    JournalCurrent Rheumatology Reports
    Issue number1
    StatePublished - 1 Jan 2021


    • Ankylosing hyperostosis
    • Ankylosing spondylitis
    • DISH
    • Diffuse Idiopathic Skeletal Hyperostosis
    • Enthesis
    • Ligamentous ossification
    • Spondyloarthritis

    ASJC Scopus subject areas

    • Rheumatology


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