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Difüz idiyopatik iskelet hiperostozu (DISH): klinik çalışma

Year 2019, Volume: 11 Issue: 2, 107 - 113, 01.06.2019
https://doi.org/10.21601/ortadogutipdergisi.431357

Abstract

Amaç: Yaygın idiopatik iskelet hiperosteozu (DISH)
henüz sebebi bilinmeyen, travmatik veya inflamatuvar değişiklik olmaksızın omurgada,
diğer eklemlerde ve ligamentlerde yaygın kalsifikasyonla karakterize kronik bir
hastalıktır. Bu çalışmada DISH sendromuyla eşlik eden hastalıklar ve rutin biyokimya
laboratuar bulguları arasındaki ilişki araştırıldı.



Gereç ve Yöntem: Çalışmaya 22 kişi (DISH grubu: 11; Kontrol
grubu: 11) alındı. Bireylerde disfaji, komorbidite (diyabetes mellitus, esansiyel
hipertansiyon, romatolojik hastalık) sorgulandı. HLAB-27, eritrosit sedimantasyon
hızı(ESR), beyaz küre sayımı, C-reaktif protein, fosfor, kalsiyum düzeyleri incelendi.
Ekstraaksiyel (omurga dışı) tutulumları göstermeye yönelik anteroposterior-lateral
pelvis, diz ve lateral ayak röntgenleri görüldü.



Bulgular: DISH sendromu olan tüm bireylerde HLAB-27
negatif bulundu ve 1 hasta yutma güçlüğü ve 1 hasta düşme sonrası gelişen parapleji
nedeniyle opere edildi ve 3 hastada omurga dışı tutulum (sakroiliak eklemlerde,
patella ve aşil tendonda) saptandı. İki grup arasında laboratuvar değerleri bakımından
istatistiksel farklılık saptanmadı. Diğer yandan DISH grubunda ekstraaksiyel tutulum
ile beyaz küre (r=-0.748, p=0.013), C-reaktif protein (r=-0.635, p=0.036) düzeyleri
arasında ve disfaji ile eozinofil düzeyi (r=-0.719, p=0.013) arasında negatif korelasyon
saptandı. DISH sendromu ile yaş, cinsiyet, komorbidite ve diğer laboratuvar değerleri
arasında korelasyon bulunmadı.



Sonuç: Bu çalışmada her ne kadar çalışma grubu küçük
olsa da DISH sendromunun ekstraaksiyel tutulum da yapabildiği, seronegatif bir hastalık
olduğu, romatizmal hastalıklardan farklı olarak kan biyokimya değerlerinde bir anormalliğe
neden olmadığı teyit edildi. Diğer yandan özellikle servikal ve torakal tutulumu
olan hastaların klinik takibinde travmaya ikincil gelişebilecek kuadripleji/parapleji
yönünden dikkatli olunması gerektiği düşünüldü.

References

  • Mader R. Diffuse idiopathic skeletal hyperostosis: time for a change. J Rheumatol 2008; 35: 377-9.
  • Cammisa M, De Serio A, Guglielmi G. Diffuse idiopathic skeletal hyperostosis. Eur J Radiol 1998; 27 (Suppl 1): 7-11.
  • Mata S, Fortin PR, Fitzcharles MA, et al. A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status. Medicine (Baltimore) 1997; 76: 104-17.
  • Forestier J, Rotes-Querol J. Senile ankylosing hyperostosis of the spine. Ann Rheum Dis 1950; 9: 321-30.
  • Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976) 2010; 35: E458-464.
  • Mader R, Novofastovski I, Iervolino S, et al. Ultrasonography of peripheral entheses in the diagnosis and understanding of diffuse idiopathic skeletal hyperostosis (DISH). Rheumatol Int 2015; 35: 493-7.
  • Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 2009; 18: 145-56.
  • Akhtar S, O’Flynn PE, Kelly A, Valentine PM. The management of dysphasia in skeletal hyperostosis. J Laryngol Otol 2000; 114: 154-7.
  • Mader R, Sarzi-Puttini P, Atzeni F, et al. Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis. Rheumatology (Oxford) 2009; 48: 1478-81.
  • Sarzi-Puttini P, Atzeni F. New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis). Curr Opin Rheumatol 2004; 16: 287-92.
  • Mazières B. Diffuse idiopathic skeletal hyperostosis (Forestier-Rotes-Querol disease): what’s new? Joint Bone Spine 2013; 80: 466-70.
  • Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 1976; 119: 559-68.
  • Whang PG, Goldberg G, Lawrence JP, et al. The management of spinal injuries in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis: a comparison of treatment methods and clinical outcomes. J Spinal Disord Tech 2009; 22: 77-85.
  • Yunoki M, Suzuki K, Uneda A, Okubo S, Hirashita K, Yoshino K. The Importance of Recognizing Diffuse Idiopathic Skeletal Hyperostosis for Neurosurgeons: A Review. Neurol Med Chir (Tokyo) 2016; 56: 510-5.
  • Utsinger PD, Resnick D, Shapiro R. Diffuse skeletal abnormalities in Forestier disease. Arch Intern Med 1976; 136: 763-8.

Diffuse idiopathic skeletal hyperostosis (DISH): a clinical study

Year 2019, Volume: 11 Issue: 2, 107 - 113, 01.06.2019
https://doi.org/10.21601/ortadogutipdergisi.431357

Abstract

Aim: Diffuse idiopathic skeletal hyperosteosis
(DISH) characterized by formation of disseminated osteofites on vertebra in the
absence of traumatic or post infectious changes is a chronic disease of unknown
etiology. This study was aimed to investigate the biochemical relationship of DISH
in patients with DISH.



Material and Method: Eleven
patients diagnosed with DISH (DIH group) and eleven patients with axial pain but
without any vertebral disease (Control group) who applied to the neurosurgery clinic
between the years 2016-2017 were enrolled in this retrospective study. HLA-B27 antigen positivity, erythrocyte sedimentation
rate, leukocyte, basofil and eosinophil counts, C-reactive protein, phosphorus and
calcium levels
, and their
results in individuals were investigated. Anteroposterior and lateral pelvis, knee,
lateral foot radiograms showing extra-axial involvement were viewed.



Results: Of the patients with DISH, one owing to difficulty
in swallowing and another owing to quadriplegia as a result of cervical trauma underwent
surgical therapy. Radiological investigations of this group revealed iliac involvement
in four patients and patellar joint involvement in one patient. There was no difference
between groups with respect to age, sex, leucocyte, basophil and eosinophil count,
C-reactive protein, phosphorus and calcium levels. However there was a significant
difference with respect to dysphagia and extra-axial involvement. No individual
was positive for HLA-B27 antigen.



Conclusion: Present study findings suggested that both
acute and/ or chronic inflammatory processes have no place in the etiology of this
disease.

References

  • Mader R. Diffuse idiopathic skeletal hyperostosis: time for a change. J Rheumatol 2008; 35: 377-9.
  • Cammisa M, De Serio A, Guglielmi G. Diffuse idiopathic skeletal hyperostosis. Eur J Radiol 1998; 27 (Suppl 1): 7-11.
  • Mata S, Fortin PR, Fitzcharles MA, et al. A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status. Medicine (Baltimore) 1997; 76: 104-17.
  • Forestier J, Rotes-Querol J. Senile ankylosing hyperostosis of the spine. Ann Rheum Dis 1950; 9: 321-30.
  • Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976) 2010; 35: E458-464.
  • Mader R, Novofastovski I, Iervolino S, et al. Ultrasonography of peripheral entheses in the diagnosis and understanding of diffuse idiopathic skeletal hyperostosis (DISH). Rheumatol Int 2015; 35: 493-7.
  • Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 2009; 18: 145-56.
  • Akhtar S, O’Flynn PE, Kelly A, Valentine PM. The management of dysphasia in skeletal hyperostosis. J Laryngol Otol 2000; 114: 154-7.
  • Mader R, Sarzi-Puttini P, Atzeni F, et al. Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis. Rheumatology (Oxford) 2009; 48: 1478-81.
  • Sarzi-Puttini P, Atzeni F. New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis). Curr Opin Rheumatol 2004; 16: 287-92.
  • Mazières B. Diffuse idiopathic skeletal hyperostosis (Forestier-Rotes-Querol disease): what’s new? Joint Bone Spine 2013; 80: 466-70.
  • Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 1976; 119: 559-68.
  • Whang PG, Goldberg G, Lawrence JP, et al. The management of spinal injuries in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis: a comparison of treatment methods and clinical outcomes. J Spinal Disord Tech 2009; 22: 77-85.
  • Yunoki M, Suzuki K, Uneda A, Okubo S, Hirashita K, Yoshino K. The Importance of Recognizing Diffuse Idiopathic Skeletal Hyperostosis for Neurosurgeons: A Review. Neurol Med Chir (Tokyo) 2016; 56: 510-5.
  • Utsinger PD, Resnick D, Shapiro R. Diffuse skeletal abnormalities in Forestier disease. Arch Intern Med 1976; 136: 763-8.
There are 15 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original article
Authors

Mustafa Öğden 0000-0002-7129-0936

Ulas Yüksel 0000-0002-6398-4110

Suleyman Akkaya 0000-0003-0597-1861

Jonathan Oppong This is me 0000-0001-7835-1204

Üçler Kısa 0000-0002-8131-6810

Bulent Bakar 0000-0002-6236-7647

Mehmet Faik Ozveren 0000-0001-7768-1519

Publication Date June 1, 2019
Published in Issue Year 2019 Volume: 11 Issue: 2

Cite

Vancouver Öğden M, Yüksel U, Akkaya S, Oppong J, Kısa Ü, Bakar B, Ozveren MF. Diffuse idiopathic skeletal hyperostosis (DISH): a clinical study. omj. 2019;11(2):107-13.

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