Characteristics

• Bone proliferation at the tendon–bone interfaces (entheses) around peripheral joints and the spine.

• Occurs relatively commonly in a middle-aged population, sometimes in conjunction with OA.

• Classically in the over 50s with a male preponderance (3:1).

• Association with diabetes mellitus.

Clinical features

• Pain and restricted movement.

• Isolated DISH is usually asymptomatic, but very often, presents alongside OA.

Radiological features

• Vertebral column – disc spaces are generally well preserved, no apophyseal ankylosis. Flowing ossification along the anterior/anterolateral aspect of at least four contiguous vertebral bodies.

• Calcaneal, olecranon and anterior patellar spurs.

• Broad osteophytes especially on the lateral aspect of the acetabulum, inferior aspect of the sacroiliac joints and superior aspect of symphysis pubis.

• Ossification of iliolumbar, sacrotuberous and sacroiliac ligaments.

• Ligamentous ossification – patellar ligament, coracoclavicular ligament and interosseous membranes.

Management

• Treat the associated osteoarthrosis.