What is diffuse idiopathic skeletal hyperostosis (DISH)?

Diffuse idiopathic skeletal hyperostosis (also known as DISH) is a type of arthritis where the tendons (the body tissues that attach your muscles to your bones) and ligaments (the tissues that hold bones together and in place) become hard and stiff. These tissues can then slowly turn into bone, usually where the tendons or ligaments meet the bone. This can cause bony spurs (growths) along the edge of the bone.

DISH usually affects your spine in the neck and upper back, but it can also affect your shoulders, elbows, hands, hips, knees and ankles.

DISH is also sometimes known as Forestier's disease or ankylosing hyperostosis.

What are the symptoms of DISH?

Some people with DISH will not have any symptoms.

If you do have symptoms, they may include:

• stiffness, usually in the morning or evening
• back pain, especially in your upper back
• shoulder, elbow, knee or heel pain
• pain when the area that is affected by DISH is pressed
• difficulty swallowing or a hoarse voice (if you have DISH in your neck)
• pins and needles or weakness in your arms or legs
• difficulty moving your neck or back

What causes DISH?

The cause of DISH is unknown, but there are some things that can make you more likely to develop DISH. These include if you:

• are male
• are older than 50 years of age
• have diabetes or pre-diabetes
• live with obesity

There is limited evidence that a medicine called isotretinoin (used for acne) may be linked to DISH-like symptoms. If you take medicine for acne, ask your doctor if it may be causing your symptoms.

You may also be at higher risk of DISH if you often move or lift heavy objects.

When should I see my doctor?

You should see your doctor if you have any of the symptoms listed or are worried that you could have DISH.

If your doctor has diagnosed you with DISH and the treatment they recommend is not working, or if your symptoms are getting worse, you should go back to your doctor for further assessment.

How is DISH diagnosed?

Your doctor will ask you about your symptoms and then do a physical examination. They may also ask you to have blood tests to help rule out other causes of arthritis.

You may also have some imaging, including an x-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan.

How is DISH treated?

There are several treatment options for DISH. Often your doctor will recommend using one or more of:

• anti-inflammatory medicines (NSAIDs)
• exercise
• physiotherapy
• making sure your blood sugar levels are well managed if you have diabetes

If you have symptoms from a bony outgrowth pressing on a nerve or affecting your swallowing, you may need surgery.

Sometimes you may find that using special equipment can make daily tasks easier if you have DISH.

Living with DISH

Living with DISH can affect both your daily routine and emotional wellbeing.

Stiffness and reduced movement may change how you plan your day or enjoy relaxing activities.

Emotional health often needs just as much attention as physical comfort. Some people may feel low in mood or anxious when living with a long‑term condition, so recognising these feelings is important.

Lifestyle choices that can help you live a healthy and balanced life include:

• gentle exercise
• balanced diet
• social connection
• hobbies and creativity
• relaxation or mindfulness

You may be scared, frustrated or angry when you are experiencing symptoms of DISH. It is important to speak to someone and get support if these feelings are affecting you.

Living with DISH is about balance. With good support networks and healthy routines, life can remain fulfilling.

Complications of DISH

If you are diagnosed with DISH and have the right treatment, you can usually live a normal life.

However, there are some more serious complications. Bony outgrowths in your neck can make it hard to swallow and cause a change in your voice. They may also press on other nerves, causing pain, sensory changes (unusual feeling) or weakness in your arms or legs.

They can also cause sleep apnoea — a condition where you stop breathing for a few moments in your sleep. DISH can also make you more likely to break a bone in your spine.

Can DISH be prevented?

It is hard to know how to prevent DISH because the cause is unknown. However, reducing your risk factors, such as making sure you look after your blood sugar levels if you have diabetes, may be able to help.

Resources and support

Arthritis Australia has a resource with more information about DISH.

The Arthritis Movement has information about DISH and provides support to people living with arthritis.

Call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known as NURSE-ON-CALL in Victoria) for more information and advice.

Languages other than English

Arthritis Queensland has some information sheets on living with arthritis in community languages.

Arthritis Australia has information sheets on arthritis and living with arthritis in many community languages.

Information for Aboriginal and/or Torres Strait Islander peoples

Visit Arthritis Australia for information on arthritis for Aboriginal and/or Torres Strait Islander peoples.