Background/Purpose:  Diffuse Idiopathic Skeletal Hyperostosis (DISH) was described based on vertebral radiological signs (Resnick). Subsequently, Utsinger presented other criteria that add extraspinal involvement that allowed DISH diagnosis even without vertebral signs. Mader et al have tried to develop a new set of criteria without a final consensus about the inclusion of multiple peripheral enthesopathies. Objective: Identify clinicoradiological patterns of DIH patients based on the spinal and / or extraspinal involvement and study their distinctive features.

Methods: We conducted a cross-sectional study of patients who fulfilled DISH Resnick’s and / or Utsinger’s criteria. Demographic, clinical, radiographic and comorbidity data were collected. Exclusion criteria: a) History of spondyloarthropathy, b) HLAB27 +, c) Personal or first degree of psoriasis or Inflammatory Bowel Disease. Variables: clinical, comorbidity and radiological variables were collected. X-rays of spine and joints (pelvis, elbows, knees, feet, hands and shoulders) were reviewed. We defined three clinical-radiological patterns: a) Peripheral: meets Utsinger’s but not Resnick’s criteria with > 3 enthesopathies. b) Axial: Resnick and Utsinger’s criteria but < 3 enthesopathies. c) Mixed: Resnick and Utsinger’s criteria but > 3 enthesopathies. Statistical analysis: We performed a univariate analysis by frequency (categorical) and main statistical and a bivariate descriptive analysis using ANOVA and Fisher’s exact test with a confidence level of 95%.

Results: we included 97 patients, 57, 7% were male. The average age at diagnosis was 65.6 y (47-85) but the age of onset of symptoms was 58.2 y (36-80). The delay in diagnosis was 6.36 years (0-25). All patients met Utsinger criteria but 25.8% did not meet Resnick’s definition. The symptoms that led to the diagnosis were: 43.7% pain and/or limitation of thoracic-lumbar spine, 16.7% pain and/or limitation cervical spine, 24% a peripheral enthesopathy, 5.2% hip pain and 10.4% was a radiological finding. We identified: a) Axial pattern (30.9%); b) Peripheral pattern (29.4%); and Mixed pattern (30.9%). Although the value of retrospective data is limited, the clinical history of enthesopathy was collected in a 46.2%. 30 patients were not eligible for statistical analysis because of lack of sufficient data. The predominance of female sex (p=0,004) and a younger age of onset (p=0,027) in peripheral pattern were statistically significative. We also found differences in presenting symptoms between those three phenotypes (p=0,014).

Conclusion: We propose three patterns in DISH based on clinical symptoms and characteristic radiological signs. We found statistical differences especially in gender, age at onset and the presenting symptoms. We need prospective studies to elucidate if they correspond to different stages or if they are different phenotypes of the disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/diffuse-idiopathic-skeletal-hyperostosis-can-we-identify-different-clinicoradiological-patterns/