Do you sometimes feel stiff when you wake up in the morning? Or do you have back pain all day long? There are two types of arthritis that affect the spine that have similar symptoms. One is DISH (Diffuse Idiopathic Skeletal Hyperostosis) and the other is AS (Ankylosing Spondylitis) . The symptoms of both are somewhat similar, which can sometimes confuse us. So today, let's talk about these two diseases in detail and clearly understand what the difference is, what the symptoms are, and how to treat them.
What causes these two diseases?
Simply put, both of these diseases affect the joints and ligaments in our spine, but the way they affect it is slightly different.
What is DISH (Diffuse Idiopathic Skeletal Hyperostosis)?
DISH is a condition in which calcium salts build up in the ligaments and tendons that surround our spine. This calcium causes those areas to gradually become as hard as bone, as if new bone is growing. Doctors don't know exactly what causes it. But they believe that genetics, environmental factors, or a combination of both may play a role.
How does Ankylosing Spondylitis (AS) develop?
It is believed that genetic and environmental factors play a role in AS. People with the HLA-B27 gene are at increased risk of developing the disease. These HLAs help our immune system distinguish between our own cells and foreign invaders. However, research is still ongoing into how this particular gene causes AS. In AS, the immune system attacks the joints in our spine. This causes inflammation, which causes stiffness and pain in the spine.
Who is most likely to develop these diseases?
There are clear differences in the age and risk factors for developing these two diseases. Let's easily understand it from this table.
| Information | DISH (Diffuse Idiopathic Skeletal Hyperostosis) | AS (Ankylosing Spondylitis) |
|---|---|---|
| Affected age | It is usually common in people over 50 years of age . | It usually begins at a young age , between the ages of 15-30. |
| Affected party | More common in men than women. | More common in men than women. |
| Other risk factors |
|
The important thing is that many people with DISH do not have any symptoms. It is often discovered incidentally when an X-ray is taken for another reason.
What are the differences in symptoms?
Although the main symptoms of both diseases are back pain and stiffness, there are clear differences in where the pain comes from, how it feels, and other accompanying symptoms.
| Characteristic | As seen on DISH | As seen in AS |
|---|---|---|
| The place where the pain occurs | Pain often occurs in the upper back. | The pain starts in the lower back. |
| The effect of exercise | No special effect. | Pain and stiffness decrease when exercising and walking. |
| Back pain | Pain can occur in places like the shoulders, elbows, knees, and heels. | Pain may occur in the ribs, shoulders, hips, knees, or feet. |
| Other special features | A bony growth in the neck may compress nerves, causing difficulty swallowing or hoarseness of the voice . | Symptoms that affect the entire body are shown. For example: - Weight loss - Extreme fatigue - Skin diseases (rashes) - Stomach pain - Vision changes (redness, pain) |
How does a doctor differentiate and diagnose these two diseases?
Diagnosing these two conditions can be a bit complicated. If you have any doubts about your diagnosis, there's nothing wrong with seeing another doctor for a second opinion.
The doctor will first ask you about your symptoms and medical history. Then he will do a physical examination. In addition, he may order these tests.
Blood Tests
In AS, testing for the HLA-B27 gene is often positive. Tests that measure inflammation in the body, such as C-reactive protein (CRP) and ESR, may also be elevated. These are usually unchanged in DISH.
Imaging Tests
These tests take pictures of the inside of the body and look for changes in the spine and joints.
- X-ray: Look for changes in the bones.
- MRI (Magnetic Resonance Imaging): Obtain detailed images of the spine, joints, and connective tissues.
- CT scan (Computed Tomography): Obtain highly detailed images.
The two diseases can be distinguished based on what is seen in these tests.
- If you have AS: You may experience inflammation and stiffness (sacroiliitis) in the joints where the spine connects to the hip bones (sacroiliac joints). Sometimes the spine may become fused together and look like a bamboo stick. This is called bamboo spine .
- If you have DISH: You can see the connective tissue that runs along the front of the spine thickening and turning into bone. But you won't see the condition of Sacroiliitis. This is one of the main factors that differentiates the two.
What are the treatments for this?
Both AS and DISH cannot be completely cured. However, with the right treatment, symptoms can be controlled and a normal life can be led. In both of these diseases, the spine is compressed, so the risk of fractures is high even with a minor accident. Therefore, it is very important to be careful.
Common treatments for both:
- Physical therapy and exercise: This is essential to strengthen the muscles around the spine and maintain flexibility in the joints.
- Painkillers: NSAIDs (Nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen reduce pain and swelling.
- Steroid injections: Steroid injections directly into painful joints can provide short-term relief.
- Surgery: This is not a common treatment, but if you have severe symptoms that cannot be controlled with other treatments, your doctor may recommend surgery.
Specific treatments for AS:
In addition to the treatments mentioned above for AS, there is a special class of drugs that reduce inflammation by changing the function of the immune system. These are called DMARDs (Disease-modifying antirheumatic drugs) . Some examples are:
- Interleukin-17 (IL-17) inhibitors (eg, secukinumab, ixekizumab)
- JAK inhibitors (eg, tofacitinib, upadacitinib)
- TNF inhibitors (eg, adalimumab, etanercept, infliximab)
- Methotrexate
- Sulfasalazine
Your doctor will determine which of these medications is most suitable for you.
Take-Home Message
- DISH and AS are two types of arthritis that affect the spine. Although the symptoms are similar, the causes and effects are different.
- DISH most commonly occurs in men over the age of 50 and often has no symptoms. AS can begin at a younger age.
- The location of the pain (DISH - above the back, AS - below the back) and the response to exercise (pain decreases in AS) help to differentiate the two.
- Your doctor will make an accurate diagnosis based on your medical history, examination, blood tests, and imaging tests (especially X-rays and MRIs).
- Although these diseases cannot be completely cured, physical therapy, medication, and lifestyle changes can help you manage your symptoms and live a successful life. Always talk to your doctor about this.
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