DISH Everywhere: Study of the Pathogenesis of Diffuse Idiopathic Skeletal Hyperostosis and of its Prevalence in England and Catalonia from the Roman to the Post-Medieval Time Period

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a spondyloarthropathy traditionally defined as having spinal and extra-spinal manifestations. However its diagnostic criteria only allow the identification of advanced DISH and there is little consensus regarding the extra-spinal enthesopathies. In this project, individuals with DISH from the WM Bass Donated Skeletal Collection were analysed to investigate the pathogenesis of DISH and archaeological English and Catalan samples (3rd–18th century AD) were studied to investigate how diet might have influenced the development of DISH. From the individuals from the Bass Collection, isolated vertical lesions representing the early stages of DISH (‘early DISH’) were identified. Both sample sets showed that the presence of extra-spinal manifestations varies significantly between individuals and that discarthrosis and DISH can co-exist in the same individual. In all archaeological samples, the prevalence of DISH was significantly higher in males and older individuals showed a higher prevalence of DISH. In both regions, the prevalence of DISH was the lowest in the Roman samples, the highest in the early medieval ones and intermediate in the late medieval samples. While when using documentary resources and archaeological data, it was hypothesised that the prevalence of DISH in the English and Catalan samples might have been different, the results show no significant differences even if English samples tend to show higher prevalence of DISH than the Catalan samples. This possibly suggests that the development of DISH depends on a combination of dietary habits and, possibly, genetic predisposition might influence the development of DISH. The individuals from the Bass Collection showed high prevalence of metabolic and cardiovascular conditions. In contrast, no association was found between DISH and rich-diet associated conditions (e.g. carious lesions and gout) or deficiency-related conditions (e.g. scurvy, healed rickets).