fetching data ... 
Background: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by calcification and ossification of ligaments and entheses, predominantly affecting the axial skeleton. DISH is associated with obesity, diabetes mellitus and hypertension, all comprising to the occurrence of metabolic syndrome (MetS). However, obesity is also associated with the occurrence of ossification due to degeneration in the axial skeleton.
Objectives: To investigate the impact of obesity on radiographic damage related to DISH vs. degenerative changes.
Methods: Patients diagnosed with MetS were identified. Demographics, clinical data, radiographic findings attributed to DISH vs. degenerative damages were recorded. Patients were categorized into four obesity classes (pre-obese and obese I–III) according to WHO criteria and were used for the impact of obesity on radiographic changes [1].
Results: A total of 124 patients were diagnosed with MetS, of whom 42 (33.9%) could be identified as having DISH based on the Resnick criteria. Demographics did not differ between DISH and no DISH (Table 1). Degenerative spondylophytes were found in 84/124 (67.7%) patients with MetS, while DISH-related chunky spondylophytes were found in 56/124 (45.2%) patients with MetS 4256 (75%) had also the diagnosis of DISH. Categorical analysis showed that obesity class II and III were significantly associated with an increased number of chunky osteophytes in all patients compared to lower obesity classes. In addition, in patients with DISH, patients with BMI ≥35 showed higher numbers of DISH-related chunky osteophytes than lower BMI classes (14.8 ±10.3 vs 9.7 ±7.7), while no significant association between BMI categories and the number of degenerative spondylophytes was found (Table 2). Overall, patients with DISH had fewer mean number of degenerative spondylophytes vs. patients without DISH (2.7±2.7 vs 4.1±4.1; p=0.04).
Conclusion: One third of patients with MetS was classified as having DISH. In MetS, BMI at higher obese classes (II and III) were significantly associated with radiographic spinal damage attributed to DISH, in contrast to degenerative spine disease, where such association was not found.
REFERENCES: [1] WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253.
Demographic and clinical data in patients with DISH and Non-DISH
| All | DISH | Non DISH | p-value | Male | Female | p-value | |
|---|---|---|---|---|---|---|---|
| n | 124 | 42 (33.9) | 82 (66.1) | - | 47 | 77 | - |
| Diabetes mellitus n, (% ) | (100) | 42 (100) | 82 (100) | - | 47 (100) | 77 (100) | - |
| Hypertension | (100) | 42 (100) | 82 (100) | - | 47 (100) | 77 (100) | - |
| DISH, n | 42 | 42 | 82 | - | 20 () | 22 () | 0.11 |
| Age, years | 66.1 (11.9) | 68.8 (10.8) | 64.7 (12.3) | 0.07 | 65.(10.4) | 66.6 (12.8) | 0.51 |
| Sex (m ) | 124 | 20 | 27 | 0.11 | 47 | 77 | - |
| BMI | 39.8 (6.3) | 40.7 (7.1) | 39.4 (5.9) | 0.27 | 40.0 (6.8) | 39.7 (6.0) | 0.83 |
| BMI 3 (≥25<30) (Preobese ) | 7 | 3 (7.1) | 4 (4.9) | 0.6 | 3 | 4 | 0.8 |
|
BMI 4 (≥30<35
)
| 20 | 3 (7.1) | 16 (19.5) | 0.07 | 10 | 10 | 0.2 |
|
BMI 5 (≥35<40
)
| 38 | 15 (35.7) | 23 (28.0) | 0.38 | 11 | 27 | 0.17 |
| BMI 6 (≥40) (Obese class II ) | 61 | 21 (50.0) | 39 (47.6) | 0.8 | 24 | 37 | 0.74 |
|
BMI 6a (≥40<45
)
| 39 | 13 (31.0) | 26 (31.7) | 0.9 | 14 | 25 | 0.76 |
|
BMI 6b (≥45
)
| 20 | 8 (19.0) | 12 (14.6) | 0.5 | 10 | 10 | 0.22 |
| Current Smoking, n=85 | 36 | 12 (28.6) | 24 (29.3) | 0.8 | 18 | 18 | 0.16 |
| Former Smoker | 11 | 4 (9.5) | 7 (8.5) | 0.7 | 6 | 5 | 0.33 |
|
Medication (Diabetes mellitus), n (%
)
| 92 | 29 (69) | 63 (76.8) | 0.8 | 30 | 62 | 0.03 |
|
Medication (Hypertension
)
| 114 | 40 (95.2) | 74 (90.2) | 0.3 | 43 | 71 | 0.9 |
| NSAIDs, n(% ) | 59 | 17 (40.5) | 42 (51.2) | 0.3 | 29 | 30 | 0.01 |
| CRP (mg/dl ) | 1.9 (3.9) | 1.7 (3.1) | 2.0 (4.2) | 0.7 | 1.5 (2.5) | 2.1 (4.5) | 0.37 |
| Creatinine | 1.0 (0.5) | 1.1 (0.6) | 1.0 (0.4) | 0.3 | 1.2 (0.4) | 1.0 (0.5) | 0.009 |
| HBA1c n=93 | 7.5 (1.4) | 7.4 (1.1) | 7.5 (1.6) | 0.7 | 7.7 (1.5) | 7.4 (1.4) | 0.36 |
| Urea | 43.7 (23.8) | 44.8 (20.5) | 43.1 (25.4) | 0.7 | 43.1 (16.7) | 44.1 (27.3) | 0.82 |
| Uric acid n=120 | 6.3 (2.1) | 6.3 (2.1) | 6.3 (2.1) | 1.0 | 6.6 (1.6) | 6.1 (2.3) | 0.18 |
| Current Back pain (yes ) | 77 | 30 (71.4) | 48 (58.5) | 0.16 | 23 | 55 | 0.01 |
| Back pain (0-10) n=88 | 6.9 (2.4) | 7.2 (2.7) | 6.8(2.3) | 0.42 | 6.9 (2.4) | 6.9 (2.4) | 0.87 |
*variables are mean ± standard deviation if not otherwise indicated; DISH: Diffuse Idiopathic Skeletal Hyperostosis, BMI: Body mass index; NSAID: Nonsteroidal Anti-Inflammatory Drug; CRP: C-reactive protein; HBA1c: Hemoglobin A1c;
Comparison of radiographic changes in patients with preobese and obesity class I with patients with obesity class II and III
| All patients
| All patients
| p | Cohens D | DISH patients
| DISH patients with obesity class II and III
| p | Cohens D | |
|---|---|---|---|---|---|---|---|---|
| Number of chunky osteophytes | 2.8 (5.5) | 6.3 (9.3) | 0.02 | -0.4 | 9.7 (7.7) | 14.8 (10.3) | 0.25 | -0.51 |
| Number of complete chunky osteophytes | 2.5 (5.3) | 5.2 (8.6) | 0.03 | -0.33 | 9.3 (7.3) | 13.4 (9.8) | 0.13 | -0.43 |
| Number of incomplete chunky osteophytes | 0.3 (0.9) | 1.1 (2.8) | 0.006 | -0.32 | 0.3 (0.8) | 1.4 (2.4) | 0.03 | -0.46 |
| Number of spondylophytes | 3.6 (4.1) | 3.6 (3.7) | 0.5 | 0.001 | 2.0 (2.9) | 2.8(2.7) | 0.28 | -0.28 |
DISH: Diffuse Idiopathic Skeletal Hyperostosis, BMI: Body mass index
Acknowledgements: NIL.
Disclosure of Interests: David Kiefer AbbVie, Eli Lilly, Galapagos, Janssen, Novartis and UCB, AbbVie, Eli Lilly, Galapagos, Janssen and UCB, Novartis, Godolias Michail: None declared, Uta Kiltz AbbVie, Amgen, Eli Lilly, Fresenius, GSK, Hexal, J&J, MSD, Novartis, UCB, AbbVie, Amgen, Eli Lilly, Fresenius, GSK, Hexal, J&J, Novartis, UCB, AbbVie, Amgen, Fresenius, GSK, Hexal, Novartis, Philipp Sewerin AXIOM Health, AMGEN, AbbVie, Astra Zeneca, Biogen, Bristol-Myers Squibb,Boehringer Ingelheim, Celgene, Celltrion, Chugai Pharma Marketing Ltd., Deutscher Psoriasis-Bund, Fresenius Kabi, Gilead Sciences, Galapagos Pharma, Hexal Pharma, Janssen-Cilag, Johnson & Johnson, Lilly, medi-login, Medac, Mediri GmbH, Novartis Pharma, Onkowissen GmbH, Pfizer, Roche Pharma, Rheumazentrum Rhein-Ruhr, Sanofi-Genzyme, Swedish Orphan Biovitrum, UCB Pharma, AXIOM Health, AMGEN, AbbVie, Astra Zeneca, Biogen, Bristol-Myers Squibb,Boehringer Ingelheim, Celgene, Celltrion, Chugai Pharma Marketing Ltd., Deutscher Psoriasis-Bund, Fresenius Kabi, Gilead Sciences, Galapagos Pharma, Hexal Pharma, Janssen-Cilag, Johnson & Johnson, Lilly, medi-login, Medac, Mediri GmbH, Novartis Pharma, Onkowissen GmbH, Pfizer, Roche Pharma, Rheumazentrum Rhein-Ruhr, Sanofi-Genzyme, Swedish Orphan Biovitrum, UCB Pharma, AbbVie, Novartis, Janssen, Cellgen, Styliani Tsiami: None declared, Ioana Andreica UCB, Astra Zeneca, Chugai, Amgen, Abbvie, Alfa Sigma, Astra Zeneca, Chugai, Gilead, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, Sobi, UCB, Amgen, Abbvie, Alfa Sigma, Astra Zeneca, Boehringer Ingelheim, Chugai Pharma, Galapagos, Lilly, Novartis, Sobi, UCB, Takeda, Lilly, Imke Redeker: None declared, Xenofon Baraliakos: None declared.
© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (