National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Diffuse idiopathic skeletal hyperostosis

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My nephew has been suffering with diffuse idiopathic skeletal hyperostosis (DISH) for 20 years. His pain has been out of control for several years and he has severe insomnia. His doctor is retiring. What type of doctor should he see who might help him with his pain?

The following information may help to address your question:


How might diffuse idiopathic skeletal hyperostosis (DISH) be treated?

Treatment of diffuse idiopathic skeletal hyperostosis (DISH) is focused on the signs and symptoms present in each person. For example, pain caused by DISH is often treated with pain relievers, such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others). Severe pain may be treated with corticosteroid injections. Muscle relaxants may also be helpful.[1][2][3]

Physical therapy and/or exercise may reduce the stiffness associated with DISH and can help increase range of motion in the joints.[1][2][3]

Even though few studies have focused on indications for surgery, it is generally accepted that surgery is indicated for people with severe symptoms (such as airway obstruction and/or dysphagia) in whom medication and therapy approaches have failed.[2][3]
Last updated: 10/13/2017

What type of specialist might someone with severe diffuse idiopathic skeletal hyperostosis (DISH) need to see?

Diffuse idiopathic skeletal hyperostosis is often treated by a rheumatologist. A pain management specialist and/or a physical therapist may also be helpful. In more severe cases that require surgery, an orthopedic surgeon or neurosurgeon may be consulted.[4][2]
Last updated: 10/31/2017

We hope this information is helpful. We strongly recommend you discuss this information with your doctor. If you still have questions, please contact us.

Warm regards,
GARD Information Specialist

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  1. Mader R, Verlaan JJ, & Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. December 2013; 9(12):741-50. http://www.ncbi.nlm.nih.gov/pubmed/24189840.
  2. Nascimento FA, Gatto LAM, Lages RO, Neto HM, Demartini Z, & Koppe GL. Diffuse idiopathic skeletal hyperostosis: A review. Surgical Neurology International. 2014; 5(Suppl 3):S122-S125. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023007/.
  3. Rothschild BM. Diffuse Idiopathic Skeletal Hyperostosis. Medscape Reference. October 5, 2017; http://emedicine.medscape.com/article/1258514-overview.
  4. Helfgott SM. Diffuse idiopathic skeletal hyperostosis (DISH). UpToDate. June 7, 2017; http://www.uptodate.com/contents/diffuse-idiopathic-skeletal-hyperostosis-dish.