Session Information
Date: Sunday, November 5, 2017
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
DISH is a non-inflammatory condition affecting the spine, and characterized by ossification of paravertebral ligaments. DISH is traditionally considered asymptomatic, detected incidentally on spine radiographs. We investigated the frequency of DISH diagnosis, the associated morbidity and healthcare utilization by patients attending our university hospital.
Methods:
Our University’s radiology database was searched from years 2005 to 2015 for the words “DISH” or “diffuse idiopathic skeletal hyperostosis” in the recorded results of spinal radiographs. Patients from the year 2015 whose spinal radiographs mentioned these words were selected for further analysis. Their spinal radiographs were re-read by two authors. Patients were divided into those who fulfilled the Resnick Criteria for DISH (Group A), and those who did not fully meet the criteria but had radiographic features suggestive of DISH (Group B). Means and proportions were used to describe variables, for group comparisons, T-test and c2 were used. A p-value less than 0.05 was considered statistically significant. All computations were done in the R statistical program.
Results:
Between 2005-2015, 3439 radiology records had DISH mentioned as a diagnosis. Out of 196 patients diagnosed with DISH In 2015, 153 fulfilled the Resnick criteria (Group A), 41 didn’t fulfill the criteria but were diagnosed as DISH by the radiologists (Group B), and 2 had erroneous diagnoses. The Table shows the comparison between the two groups. Thoracic radiographs where DISH was mentioned were more likely to fulfill the Resnick criteria than not (35% vs 15%) compared to other radiographs (p < 0.03). Chronic back pain was very common in both groups, and more often reported in Group B than Group A (81% vs. 63%, p = 0.04). Back pain was the reason for performing the initial diagnostic radiograph in 45% of Group A and 61% of Group B. A substantial portion of patients required opioid medications for pain control (51%), spinal surgery (31%), and consultations with various specialists for regional pain (57%). Health care interventions were similar in both groups.
Conclusion:
DISH is a common diagnosis with significant morbidity, despite being commonly considered to be an asymptomatic condition. Majority of DISH patients had chronic back pain, required opioid medication, and a large proportion required spinal surgery. Future research is needed to systematically assess the healthcare utilization by DISH patients.
Table: Comparison of DISH patients: those fulfilling Resnick criteria vs. not fulfilling Resnick criteria but diagnosed by radiologists (ns = not significant)
|
Variable |
Group A: Resnick Criteria fulfilled (n = 153) |
Group B: Resnick Criteria not fulfilled (n = 41) |
p |
|
Age in years (mean) |
70.6 |
62.4 |
p < 0.01 |
|
Male Gender |
110 (72%) |
33 (28%) |
p = ns |
|
BMI |
32.34 |
32.83 |
p = ns |
|
Chronic Back Pain |
96 (63%) |
33 (81%) |
p = 0.04 |
|
Type 2 Diabetes Mellitus |
19 (12%) |
3 (7%) |
p = ns |
|
Hypertension |
33 (22%) |
8 (20%) |
p = ns |
|
Hyperlipidemia |
19 (12%) |
5 (12%) |
p=ns |
|
Gout |
10 (7%) |
2 (5%) |
p = ns |
|
Type of Radiograph Spinal Survey Cervical Thoracolumbar Thoracic Lumbar Sacroiliac |
2 (1%) 12 (8%) 11 (22%) 53 (35%) 68 (45%) 3 (2%) |
1 (3%) 6 (15%) 0 (NA) 6 (15%) 26 (66%) 0 (NA) |
p = 0.03 |
|
Reason for X-ray DISH Pain Other |
5 (3.3%) 69 (45%) 78 (51%) |
0 (NA) 25 (61%) 16 (39%) |
Pearson’s c2 p = ns
|
|
Opioid Use |
77 (54%) |
22 (50%) |
p = ns |
|
Bisphosphonate Use |
1 (1%) |
0 (0%) |
p =ns |
|
Spinal Surgery |
46 (31%) |
14 (34%) |
p = ns |
|
Spinal Pumps |
1 (1%) |
0 (0%) |
p =ns |
|
Consultations Neurology Orthopedics Rheumatology Physical Medicine and Rehabilitation |
8 (6%) 59 (42%) 7 (5%) 5 (4%)
|
3 (8%) 23 (59%) 2 (5%) 1 (3%) |
p = ns |
To cite this abstract in AMA style:
Tripathi M, Rajmohan D, Quirk C, Beckett B, Choi D, Rich-Garg N, Deodhar AA. Frequency, Morbidity and Healthcare Utilization of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Patients at a University Hospital [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/frequency-morbidity-and-healthcare-utilization-of-diffuse-idiopathic-skeletal-hyperostosis-dish-patients-at-a-university-hospital/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/frequency-morbidity-and-healthcare-utilization-of-diffuse-idiopathic-skeletal-hyperostosis-dish-patients-at-a-university-hospital/