Diffuse Idiopathic Skeletal Hyperostosis Syndrome Research Articles

Timing for surgical intervention in DISHphagia.

Introduction:Dysphagia in old patients secondary to diffuse idiopathic skeletal hyperostosis (DISH) syndrome is underdiagnosed. Surgical resection of the offending osteophytes is the definitive treatment. However, the timing of surgery in the course of the disease is still controversial. The study tries to find a correlation if any, between the timing of osteophytectomy surgery aimed to relieve DISH syndrome-induced dysphagia and the surgical outcome.Methods:During the period from 2010 to 2015, clinical and radiological data of patients who presented with dysphagia attributed to DISH syndrome were retrospectively reviewed along with their management and outcome.Results:One female and seven male patients were included in the study. Mean age was 71 years. Mean duration of dysphagia was 3 years and 10 months. Surgical resection was attempted through anterolateral cervical approach in five cases who were fit for surgery, in which four showed complete resolution of dysphagia (one experienced transient hoarseness of voice for 4 weeks postoperatively), and the fifth showed minimal improvement after limited resection due to intraoperative finding of marked esophageal adherence to osteophytes. The two unfavorable outcomes (subtotal resection and transient hoarseness of voice) occurred in relatively older patients (average: 75.5 years) with longer standing dysphagia (average: 7 years).Conclusion:DISH syndrome as a cause of dysphagia is commonly underlooked. Surgical resection of the offending osteophytes through an anterolateral approach is a safe and effective procedure. For patients who are fit for surgery, older age or longer duration of dysphagia might be associated with less favorable surgical outcome.

Atypical Presentation of Osteomyelitis, Discitis, Epidural, and Iliopsoas Abscess in Diffuse Idiopathic Skeletal Hyperostosis (DISH) Syndrome

Spine infections are infrequent but important sources of back pain, posing significant risk of neurological sequelae. Risk factors include diabetes, recent trauma or instrumentation, and infection. Pathogens include Staphylococcus aureus and beta-hemolytic Streptococcus. A 67-yr-old man presented with lower back and hip pain of 2-mo duration without fever. Initial treatment and work-up revealed diffuse idiopathic skeletal hyperostosis. The patient did not improve with conservative care, and neurologic decline was recognized. Magnetic resonance imaging identified osteomyelitis, discitis, and epidural abscesses at the L4-L5 levels. Escherichia coli was identified, and antibiotic treatment with CT-guided drainage precluded the need for surgery. Spine infections and iliopsoas abscesses are conditions that can result in serious disability. Awareness of unusual diagnoses and atypical pain presentations in patients with chronic spine pathology, such as diffuse idiopathic skeletal hyperostosis syndrome, is important to recognize early to minimize neurological sequelae.

Single‐center retrospective study of long‐term use of low‐dose acitretin (Soriatane®) for psoriasis

BACKGROUND: Indicated as monotherapy for severe psoriasis in adults, acitretin (Soriatane®) can be used in combination therapy or as a ‘disease‐stabilizing, maintenance’ agent. While its efficacy for psoriasis and other disorders of keratinization is well established, its safety is often a concern for many dermatologists. The possible side effects associated with short‐term treatment of oral retinoids include mucocutaneous effects, elevation in serum lipid chemistries and liver enzymes, and teratogenicity. However, the only possible long‐term, cumulative side effect is skeletal and ligamentous calcification such as hyperostosis. There is a specific syndrome of hyperostosis associated with oral retinoids called DISH (diffuse idiopathic skeletal hyperostosis).OBJECTIVE: To examine the incidence of DISH syndrome in long‐term acitretin use for psoriasis and to quantify the incidence of other side effects.METHODS: All patients seen at the UCSF Psoriasis and Skin Treatment Center who had been on acitretin for more than 1 year were identified.RESUTLS: A chart review of these patients revealed no X‐ray‐confirmed cases of DISH syndrome, minimal changes in coronary heart disease risk indicators, and extremely rare significant elevation of liver enzymes.CONCLUSION: Acitretin does not appear to cause significant long‐term side effects at low doses; the implications for thousands of patients are that use of this medication can be continued for long periods of time with routine monitoring.

Spondylosis in sand rats: A model of intervertebral disc degeneration and hyperostosis

This study defines gross, histopathologic, and radiologic changes associated with intervertebral disc degeneration in a spontaneously occurring form of the disease in aging sand rats (Psammomys obesus). Sand rats (male/female) fed lab chow supplemented with desert salt bush were sacrificed at periods of 3-30 months. Lateral thoracolumbar spine films were obtained. At sacrifice, spines were surgically exposed and gross findings were recorded; after fixation/decalcification, histopathologic studies were carried out using hematoxylin and eosin, and Safranin-O with fast green counterstain. Metabolic studies included correlations of pathologic and radiologic findings with blood glucose and insulin levels. Disc-space narrowing and subchondral endplate sclerosis increased radiologically with age, with more severe lower lumbar disc lesions. Ligamentous calcifications ventral to involved discs and caudal vertebrae were common. Disc thinning and anterior vertebral bony/cartilaginous spurs were more marked with age. Microscopy revealed loss of nucleus pulposus physaliform cells, chondrocyte replication, disc necrosis, and ossification. Hyperglycemia with and without hyperinsulinemia was common. No statistically significant differences in pathologic findings were noted, neither in diabetic versus nondiabetic nor in hyperinsulinemic animals. The sand rat is a model of disc degeneration; similarities with possible overlap with diffuse idiopathic skeletal hyperostosis syndrome were noted.