Tag: ankylosing spondylitis

DISH What Next – Prognosis Not Good

~ quantumdreamer ~ Leave a comment

As Toyah might say, “It’s a mystery”. If you read a review article from 2023 claiming that something is unclear in journalistic language understatement, it is clear that they do not know why Diffuse Idiopathic Skeletal Hyperostosis occurs nor how come. There are correlated but not proven causative factors.

They could call it “strange bony growth disease we don’t understand” but that would impinge on the sacred deity of jargon.

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idiopathic

adjective

1: arising spontaneously or from an obscure or unknown cause

2: peculiar to the individual

An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin.

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Eshed, I.

Imaging Characteristics of Diffuse Idiopathic Skeletal Hyperostosis: More Than Just Spinal Bony Bridges.

Diagnostics 2023, 13, 563.

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https://doi.org/10.3390/diagnostics13030563

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“The body of knowledge regarding imaging characteristics has grown over the last decade. The current Resnick and Niwayama criteria for DISH correspond to an endstage diagnosis of the disease, in which the spine is already ankylosed. A newer set of classification criteria is warranted for diagnosis in an earlier, pre-ankylotic stage of the disease.

The pathogenesis underlying this disease is still unclear, and although it is thought to be a degenerative disease, it has been suggested that similarities to SpA may imply an inflammatory basis. Imaging studies further characterizing the disease may potentially aid in deciphering the currently obscure pathogenesis of DISH.”

SpA is spondylarthritis or ankylosing spondylitis

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I would have to place myself in the advanced stages given what I have read.

The physiotherapist today said that the prognosis for me is not good. The bony growths will probably grow and I will get more and more rigid and unable to bend. Because of the rigid spine I will increasingly be at risk of spinal fracture. The rigid part is long.

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The “rigid” part of the lever may snap.

If the DISH spreads to my cervical spine there are risks associated with oral intubation causing cervical spine fracture. It makes general anaesthesia slightly riskier.

Hip replacements are more likely to suffer prompt bony over growth. This means that they would probably last less long before failure.

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“Heterotopic ossification is a common complication following total hip arthroplasty in patients with DISH, occurring in 30% to 56% of cases. In contrast, patients without DISH in the cited studies had a much lower rate of heterotopic ossification, ranging from 10% to 22%.”

Prognosis

The prognosis of DISH varies based on the severity of the condition and the symptoms experienced by the individual. While DISH is a progressive disorder, it typically advances slowly. Most individuals can manage their symptoms with conservative treatments, such as physical therapy, pain management, and maintaining an active lifestyle to preserve range of motion. However, in some cases, DISH can lead to significant complications, including severe spinal stiffness, nerve compression, and difficulties with swallowing or breathing if calcification extends to the cervical or thoracic regions.

Rarely, surgical intervention may be necessary to relieve compression or correct severe deformities. Overall, while DISH can affect quality of life, especially in advanced stages, it is not typically life-threatening. With proper management, many patients are able to maintain a functional level of mobility.

Luo TD, Varacallo MA. Diffuse Idiopathic Skeletal Hyperostosis. [Updated 2025 Jan 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

Available from: https://www.ncbi.nlm.nih.gov/books/NBK538204/

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There are other knock on effects, bony growths in weird places including aorta and heels.

I may get have to get used to the terms ossification and calcification. A brief inspection of the internet struggles to find much on severe DISH. It seems taboo or just not click worthy. My CT images look top end advanced.

I have not yet had a formal diagnosis. I have learned that this might make me a DISHie and that there are support groups on line. They say that it can take ages, years, to get diagnosed and that most have co-morbidities, one of which is often ankylosing spondylitis.

I might, in due course, become a lab rat and a participant in the on line groups.

My days dancing at the Bolshoi had to end sooner or later…

Loose Ends

~ quantumdreamer ~ Leave a comment

Thematically the notion of loose ends has been active in the period of hibernal sleep, pralaya, before the post equinox activity.

“Pralaya is the period of sleep between cosmic revolutions as well as dissolution of the body and cosmos.”

The skirmish with the coypu is coming to a close, there is about 10 m more of fencing to repair on the northern boundary, the single wire, six conductor, five string electric fence, is offering deterrent. There has been no sign of coypu in the pond for a week now.

Finally, after an hour or so on the ‘phone and with an abortive attempt I have managed to replace the UK secure banking thingy. I have had a couple of nice chats with Indian gentlemen in the sub-continent. One of them had a nice sense of humour when I asked for a 50:50 or ‘phone a friend for one of his questions.

I await a replacement Carte Vitale; the current estimate is two more weeks…

I have asked for an HLA – B27 genotype test which will help to close /open one door concerning a diagnosis for my back pain. A telephone call to the surgery on Monday will see if there is a prescription waiting. Although there is an MRI appointment early April for an S5 – L1 investigation I am not sure there is a point to it, nor if it justifies the price. If I get a positive HLA -B27 test then I can ask the GP to change the target of the MRI to sacroiliac joints which can be diagnostic of ankylosing spondylitis. If no test is forthcoming, I could just go though the motions and let it all drop until next year. I asked, it was ignored, let it play. Do not inflict myself. Do not push or strive.

I have been following up on the Brisbane property title deed prompted by the recent dream. The title search reported four properties in the same full name as my father, two near Brisbane and two near Cairns. One of the titles fits my memory and there are two > $1 million Australian properties on the plots. I have asked for a historical title search from registry this morning. This is probably only for historical interest.

I get a Titanium tooth root drilled in in a couple or weeks to be followed by a crown in a few months. Three teeth are similar in price to an old style, non-computational, second hand car. First pass is to only get one done; the other side of my mouth can remain nonfunctional.

The tuner in our satellite TV decoder failed and we await a replacement from Ireland. I will tune the receiver dish to Astra 2 in geo-stationary orbit and we will have UK TV back, fingers crossed. Watching rugby with French commentary is not the same.

I know this is a dangerous thing to say. But there does not seem to be any actions on my part outside of these currently on my to do list. Nor does there seem any other than gardening or medical for the near future.

I may be a loose end for others, but I see no action required of me. This seems unlikely as I am not “in” (m)any other lives.

On the back burner there are noises that the French property market is starting to warm a tiny bit perhaps aided by the ECB interest rate decision last week. The chronic decision of house down-sizing may come onto the cards later in spring-summer.

Yep, there are curve balls, spanners etc…

Then on the horizon is the big-one. In March 2026 our right to stay expires along with our health rights, our bank cards. Everything French except my driver licence runs out on the same day. We may get booted out back to blighty.

Given the right wing nationalist rhetoric which can be found on many sides, our future here does not look as secure as it did two years ago.

Gee thanks Donald and Elon and Boris…

This residence thing needs watching, hopefully something is put in place in a timely fashion. Though it could be a lastminut.com lash up.

This morning, I was awoken by the dawn chorus, there are daffodils and primroses, the roses are budding. Spring is putting her toe through the threshold of the year…

Medical Merry-go-round

~ quantumdreamer ~ Leave a comment

After the visit to the orthopaedic surgeon no replacement hip surgery is currently foreseen. Instead, I have been referred to a spinal column – pelvis surgeon following a programmed (S5-L1) MRI. They will use the water (T1) and fat (T2) resonance decay times to determine if the nerve roots are entrained, pressed upon. There is no neuropathy so this seems unlikely. I will be back to square one, I will not pass Go, nor collect £200.

Way back in ~1994 the Imperial College heath centre were trying to figure out why I was having major pain in my lower spine and pelvis. There was very restricted motion of my hips. They mentioned ankylosing spondylitis (AS). It went on for months and they could not figure out what was going on. There was a lot of pain and this preceded my depressive breakdown ~1995-7. The prospect of incurable ankylosing spondylitis as a ~30 year old is not an attractive one.

I am going to ask the general practitioner for a blood test for the human leukocyte antigen (HLA) B27 which is strongly implicated in AS.

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There are some very lengthy forms for genetic consent here in France.

If this suggests AS I may be on the NSAIDs and Tumour Necrosis Factor Inhibitors. One of which is lenalidomide which the wife takes for multiple myeloma.

TNF

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I would like some more clarity before anyone reaches for the knife…