Forestier’s Disease is a rare form of degenerative arthritis. More commonly known as diffuse idiopathic skeletal hyperostosis (DISH), this disease attacks the ligaments of the body and turns them to bone.
The process is caused by the buildup of calcium salts in the ligaments and tendons, creating abnormal new bone growth (ossification). Doctors are unsure what causes this process to occur, but some suspect there is a genetic component. The hardening of the ligaments leads to joint stiffness and eventual loss of mobility.
DISH can occur in any part of the body, but most commonly affects the spine and lower back. Some people have DISH in their neck ligaments, which can make swallowing difficult. Other areas affected include the shoulders, elbows, ribs, knees, feet and ankles.
When it attacks the ligaments of the feet and ankles, DISH results in heel spurs, small sharp growths of bone that appear along the heel. DISH can be progressive. As it worsens, it can cause serious complications.
Causes of DISH
- Sex. Men are more likely to develop DISH than women.
- Age. DISH is most common in older adults, especially in people older than 50.
- Diabetes and other conditions. People with type 2 diabetes might be more likely to develop DISH than are those who don’t have diabetes. Other conditions that can raise insulin levels in your body may also increase your risk, including hyperinsulinemia, prediabetes and obesity.
- Certain medications. Long-term use of medications called retinoids, such as isotretinoin (Amnesteem, Claravis, others), which are used to treat skin conditions such as acne, can increase your risk.
Symptoms of DISH
DISH does not initially produce symptoms. As it progresses, you might experience:
- pain and stiffness in your joints, especially in the morning
- loss of motion in your feet, lower back and other affected areas
- inability to stretch fully
- pain in your back, knee or heel
- Loss of range of motion
- Tingling, numbness, and/or weakness in the legs
- Spinal fractures and increased risk of breaking other affected bones
- Compressed or pinched nerves (radiculopathy)
- Compressed spinal cord (myelopathy) which can lead to partial or complete paralysis of the legs and/or arms (paraparesis, tetraparesis)
- Difficulty swallowing (dysphagia)
- Hoarse voice or difficulty speaking (dysphonia)
- Sleep apnea
- Decreased lung capacity (if DISH affects the ribs)
- Difficulty breathing possibly due to airway obstruction
You should always consult a doctor if you’re experiencing pain and stiffness or if you have bone spurs.
In most cases, DISH causes mild discomfort, allowing patients who have it to live with the symptoms through a combination of pain relievers, stretching exercises, other interventions and in rare cases, surgery to remove bone growth.
For others, the disease may continue to progress which can result in a complete loss of mobility in the affected joints. For instance, if you have DISH in your shoulder, it can make it difficult to raise your arm or move it in all its natural positions.
Fractures are a serious complication of DISH because the stiffness of your tendons makes your bones more likely to fracture if you’re injured.
One huge drawback with DISH is that the pain and stiffness can mimic many other conditions, so proper diagnosis and treatment is essential.
Diagnosis and Treatment
A diagnosis of diffuse idiopathic skeletal hyperostosis (DISH) is often suspected by the signs and symptoms a person has. X-rays can confirm the diagnosis. In some cases, a computed tomography (CT scan) and/or magnetic resonance imaging (MRI) may also be ordered to rule out other diseases that cause the same symptoms. All three types of imaging studies may be used to see which other areas of the skeleton are affected by DISH.
There is no cure for DISH, but you can
- Treat underlying conditions. If you have diabetes or another condition associated with insulin resistance, getting that condition under control will help minimize the symptoms of DISH. Maintaining a healthy weight will also help.
- Get pain relief. Ask a podiatrist for pain relievers that can treat joint stiffness in your legs, feet, and ankles. Your doctor might prescribe corticosteroid injections for more severe pain.
- Increase mobility. Gentle stretching exercises can keep your ligaments from becoming overly stiff and brittle. Ask your doctor to recommend a regimen for your joints that will keep them moving. Walking, bicycling, and Aqua exercises are all excellent ways to stay mobile.
My Personal Experience
I was diagnosed with DISH in 2014 after going to the Emergency Room for chest pain. After a number of tests were done, including a CT Scan, the doctor informed me that they had discovered I had DISH in my Thoracic Spine (after ruling out heart problems for the chest pain).
I had always had pain and stiffness in my spine but assumed it was “regular” arthritis, as I have Osteoarthritis throughout my body. Finding out it was something different came as a surprise to me. I discovered that because I have Diabetes Type 2, it was likely a contributing factor. In the years since the diagnosis, I have developed bone spurs in my left ankle, and the DISH has spread to include my Lumbar spine as well as the Thoracic spine. The bone spurs on my spine look more like melted candle wax than actual spurs which is typical for this disease.
I find the stiffness is the most difficult part of having DISH. The sensation is like trying to stretch, but never quite getting enough range of motion, so you’re left feeling “incomplete.” It’s almost like one good “pop” would make things better. I do stretching exercises and use a foam roller to help minimize the stiffness, and I’m conscious of my voice as well. I’ve developed some hoarseness over the years which could indicate that the DISH has affected my cervical spine.
I don’t take any additional medication for DISH with the exception of an occasional muscle relaxant if my back is particularly stiff. By relaxing the muscles around the spine, I get some relief from the stiffness that is part of DISH. I find that my stretching exercises are usually effective enough to bring relief. Heat sometimes helps with the stiffness as well, and a good muscle rub or magnesium rub can make a difference in pain levels as well.
If you are experiencing pain and stiffness in the spine or noticing that you are developing bone spurs on your feet (or hands), consult with your doctor and ask about whether DISH could be causing your problems. X-rays and/or other imaging tests can help to determine if there are problems with the ligaments or if there is increased bone growth.
Discovering DISH early can help you get a treatment plan in place to provide relief. Although DISH is considered “rare”, it seems like it’s becoming more predominant than in the past so the sooner you get a diagnosis, the better.
Resources and Further Reading
Pamela Jessen lives in Langford, BC Canada. She is a blogger who writes about Chronic Pain, Chronic Fatigue and Invisible Illness at pamelajessen.com. She also writes for The Mighty, PainResource.com and various independent publications. Pamela is also a Patient Advocate with the Patient Voices Network in BC. She sits on 4 committees and one Provincial working group and has also been involved in advocacy work at the Canadian National level as well. Pamela is married to her amazing husband Ray and they have one cat named Dorie.