|
Diffuse idiopathic skeletal hyperostosis (DISH, also known as Forestier's disease, senile ankylosing spondylosis, and ankylosing hyperostosis) is a non-inflammatory spondyloarthropathy of the spine. It is characterized by spiny ankylosis and enthesopathy (ossification of the ligaments and entheses). It most commonly affects the thoracic and thoraco-lumbar spine, but involvement is variable and can include the entire spine. The disc spaces, facet and sacroiliac joints remain unaffected. Diagnosis requires confluent ossification of at least 4 contiguous vertebral bodies.〔 Classically, advanced disease may have "melted candle wax" appearance along the spine on radiographic studies.〔Waldron, T. "Paleopathology". Cambridge University Press, 2009, p. 73.〕 The calcification and ossification is most common on the right side of the spine. In people with dextrocardia and situs inversus this calcification occurs on the left side, which confirms the role of the descending thoracic aorta in preventing the physical manifestations of DISH on one side of the spine.〔Forestier, J., Lagier, R.; Ankylosing hyperostosis of the spine. Clin. Orthop. 1971; 74:65〕 ==Etiology== The exact cause is unknown. Mechanical factors, dietary and long term use of some antidepressants may be of significance. There is a correlation between these factors but not a cause or effect. The distinctive radiological feature of DISH is the continuous linear calcification along the antero-medial aspect of the thoracic spine. The disease is usually found in people in their 60s and above, and is extremely rare in people in their 40s and 30s. The disease can spread to any joint of the body, affecting the neck, shoulders, ribs, hips, pelvis, knees, ankles, and hands. The disease is not fatal, however some associated complications can lead to death. Complications include paralysis, dysphagia (the inability to swallow), and pulmonary infections. Although DISH manifests in a similar manner to ankylosing spondylitis, these two are totally separate diseases. Ankylosing spondylitis is a genetic disease with identifiable marks, and affects organs. DISH has no indication of a genetic link, and does not affect organs other than the lungs, which is only indirect due to the fusion of the rib cage.〔 Treatment of acne with vitamin derived retinoids was noticed to be associated with similar manifestations in some patients especially with Etretinate〔DiGiovanna JJ; Helfgott RK; Gerber LH; Peck GL Extraspinal tendon and ligament calcification associated with long-term therapy with etretinate SO N Engl J Med 6 November 1986;315(19):1177-82. PMID 3463863 〕 which is no longer available for clinical use. other retinoids, like acitretin may cause extraspinal hyperostosis.〔 DiGiovanna JJ Isotretinoin effects on bone. J Am Acad Dermatol 2001 Nov;45(5):S176-82.〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Diffuse idiopathic skeletal hyperostosis」の詳細全文を読む スポンサード リンク
|