Clinical features

The clinical features include:

• asymptomatic disease
• some patients have spinal stiffness only
• most symptomatic patients have reduced mobility of the spine associated with back pain
• disease usually affects the thoracic spine
  
  
• other possible features include:
  • peripheral joints manifestations
    • peripheral joint involvement in DISH has some distinctive features (1,2,3,4):
      
      
      • involvement of joints usually unaffected by primary osteoarthritis (OA - e.g., hip and knee)
        • osteoarthritis involving joints usually not affected by OA such as the elbow and shoulder
        • foot and ankle involvement has been reported in up to 70% of patients
          • clinical and radiographic findings are often consistent with heel spurs, Achilles tendinitis, and plantar fasciitis
            
            
      • increased hypertrophic changes compared with primary OA
        
        
      • prominent enthesopathies adjacent to peripheral joints
        • enthesopathies related to joints (ie, tibial tuberosity, elbow) and in sites unrelated to joints (ie, plantar fascia, iliolumbar ligament)
      • calcification and ossification of entheses in sites other than the joints
        
        
    • peripheral findings often include hyperostosis and tendonitis
      
      
    • in the pelvis, enthesophytes involving the iliac wing and ischial tuberosity may be present
      
      
    • periarticular hyperostosis and tendinous ossifications have also been reported in the hip, knee, shoulder, elbow, hand, and wrist

Reference:

• Beyeler C, Schlapbach P, Gerber NJ, et al. Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a cause of elbow pain? A controlled study. Br J Rheumatol 1992;31:319-23.
• Littlejohn JO, Urowitz MB, Smythe HA, et al. Radiographic features of the hand in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 1981;140:623-9.
• Beyeler C, Schlapbach P, Gerber NJ, et al. Diffuse idiopathic skeletal hyperostosis (DISH) of the shoulder: a cause of shoulder pain? Br J Rheumatol 1990;29:349-53.
• T . David Luo; Matthew Varacallo. Diffuse Idiopathic Skeletal Hyperostosis (DISH). StatPearls.