A geriatric patient with diffuse idiopathic skeletal hyperostosis

The most frequent health problems seen in senility are chronic and degenerative diseases. A 75-year-old male patient with the complaints of weight loss and difficulty in swallowing was admitted to our hospital from a nursing home. Upper system fiber-optic gastrointestinal endoscopy was performed and a mass at the junction of the hypopharynx and esophagus just below recessus piriformis obstructing almost the whole of the lumen and blocking the distal passage was detected. Computed tomography revealed marked narrowing secondary to osseous hypertrophy in the air column of the hypopharynx and proximal esophagus. Diffuse idiopathic skeletal hyperostosis or Forestier’s disease is an idiopathic disease characterized by the ossification of the anterior longitudinal ligament of vertebra and some of the extraspinal ligaments. In the present case we aim to discuss an elderly patient who suffered from dysphagia and weight loss and the diagnostic stages.

Rapid remission of refractory synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome in response to the Janus kinase inhibitor tofacitinib: A case report

BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome is a rare autoinflammatory disease for which clinical treatment has not been standardized.Janus kinase(JAK)inhibitors represent a novel therapeutic option for rheumatoid arthritis,psoriatic arthritis,and some other autoinflammatory diseases.However,the clinical utility of JAK inhibitors in treating SAPHO syndrome has not been thoroughly investigated.In this study,we describe a patient with SAPHO syndrome who failed to respond to conventional treatment but demonstrated a remarkable and rapid response to the JAK inhibitor tofacitinib.CASE SUMMARY A 62-year-old female patient presented with swelling and pain at the sternoclavicular joints,back pain that limited her activities,arthralgia in the right knee,and cutaneous lesions.Her symptoms were unresponsive to nonsteroidal anti-inflammatory drugs,disease-modifying antirheumatic drugs,Tripterygium wilfordii hook f,and bisphosphonates.SAPHO syndrome was diagnosed in accordance with dermatological and osteoarticular manifestations and abnormal inflammatory factors.Multiple image studies have illustrated bone lesions and pathological fractures of vertebral bodies.Oral treatment with tofacitinib at 5 mg twice daily with methotrexate and bisphosphonates was initiated.The patient reported that her pain symptoms were relieved after 3 d and her cutaneous lesions were reduced after 4 wk of treatment.Vertebral lesions were improved after 6 mo on tofacitinib.No serious adverse effects were noted.CONCLUSION JAK inhibitor therapy may be a promising strategy to treat SAPHO syndrome.

Extraskeletal symptoms and comorbidities of diffuse idiopathic skeletal hyperostosis

Diffuse idiopathic skeletal hyperostosis(DISH) is a noninflammatory disease characterized by calcification and ossification of soft tissues, mainly enthesis and spinal ligaments. The clinical presentation primarily includes spinal involvement-induced pain and range of motion. Although rare, life-threatening gastrointestinal, respiratory or neurological events or severe morbidity due to bone compression on the adjacent structures may develop. There is a limited amount of data on DISHrelated events in the literature. In recent years, comorbid metabolic disorders are of great interest in patients with DISH. The early diagnosis of these conditions as well as rare entities allows an effective multidisciplinary approach for the treatment of DISH. In this article, we review extraskeletal symptoms and associated comorbidities in patients with DISH.

Successful Treatment of Spine Fracture for Diffuse Idiopathic Skeletal Hyperostosis with Teriparatide—A Report of Two Cases

We experienced 2 cases of spinal fracture in patients aged 80 years or older with diffuse idiopathic skeletal hyperostosis (DISH). Since they decided not to undergo surgical treatment, we provided conservative treatment with teriparatide. There has been no previous study on teriparatide for spine fracture in DISH. This is the first report of the successful use of teriparatide to treat spine fracture in DISH without surgical intervention. Our patients were treated with teriparatide for 8-9 months after diagnosis of the fracture. Union was obtained in two cases and no adverse events were observed during treatment. Our report showed that teriparatide could be an alternative to conventional intervention in spinal fracture of DISH.

Young thoracic vertebra diffuse idiopathic skeletal hyperostosis with Scheuermann disease:A case report

BACKGROUND Diffuse idiopathic skeletal hyperostosis(DISH)is a disorder characterised by the calcification and ossification of ligaments and entheses.It is a frequent occurrence in elderly males,but rarely encountered in younger individuals.CASE SUMMARY A 24-year-old male was admitted to the hospital due to low back pain accompanied with numbness in both lower limbs for 10 d.Upon clinical examination and imaging tests,the patient was diagnosed with DISH with Scheuermann disease and thoracic spinal stenosis.Before the operation and medical treatment,the patient had hypoesthesia of the skin below the xiphoid process.Afterward,a standard laminectomy was conducted using ultrasonic bone curette and internal fixation was applied.Subsequently,the patient was given corticosteroids,neurotrophic drugs,hyperbaric oxygen and electric stimulation.As a result of the treatment,the patient’s sensory level decreased to the navel level and there was no major change in the muscle strength of the lower limbs.During follow-up,the patient’s skin sensation has returned to normal.CONCLUSION This case is a rare instance of DISH co-existing with Scheuermann’s disease in a young adult.This provides a valuable reference point for spine surgeons,as DISH is more commonly observed in middle-aged and elder adults.

Cervical Disc Arthroplasty Combined with Interbody Fusion for the Treatment of Cervical Myelopathy with Diffuse Idiopathic Skeletal Hyperostosis： A Case Report

Diftuse idiopathic skeletal hyperostosis （DISHL also known as Forestier＇s disease, was originally reported by Forestier and Rotes-Querol in 1950. It is a common but underdiagnosed skeletal disease characterized by massive ossification of the anterior longitudinal ligament of several vertebral bodies. The most common symptom of cervical DISH is dysphagia due to mechanical compression of the esophagus. Reports of cervical myelopathy associated with DISH are rare. Here, we present a case describing a DISH patient with cervical myelopathy who was effectively treated by a carefully designed surgical procedure.

Correlation between obesity and female hyperostosis

Background Hyperostosis is a common pathological change among people more than 50 years old; it is connected with many risk factors, which are all indefinite. The aim of this study was to prospectively investigate the correlation between obesity and female hyperostosis. Methods Totally 4326 females were included in this study and their basic information including their age, stature, body weight, course of disease, symptoms, medical complications, frequency of exercise and smoking, and X-ray and bone mineral density （BMD） examination results, was carefully collected for a statistical analysis. The t test or X^2 test was used to evaluate the differences between two groups; an analysis of variance （ANOVA） was used to evaluate the differences among several groups; the relationship between hyperostosis and body mass index （BMI）, age, medical complications, exercise, average BMD was analyzed using Logistic regression. Results The incidence rate of hyperostosis in obese patients was higher than that in patients with normal weight （,0=-0.000）. Obesity was relevant to hyperostotic sites （P=0.000）, and the incidence of hyperostosis in one or several sites of the lumbar vertebrae, knee joints, and other sites was higher in obese patients than in patients with normal weight. There was also a difference in the extent of hyperostosis between these two groups. BMI had positive effects on the incidence and degree of hyperostosis, which were also relative to the sites of hyperostosis, and the BMI of patients without hyperostosis were much lower than those of the patients with hyperostosis in their lumbar vertebrae, knee joints, or multiple sites. Obesity, age, and exercise had positive effects on the incidence of hyperostosis （P=0.002, 0.000, 0.018）. Conclusions Obesity is a significant potential stimulant of hyperostosis, especially hyperostosis in knee joints and multiple sites; keeping fit might be an important way to prevent it.

肥胖症与弥漫性特发性骨肥厚症的关系

背景:弥漫性特发性骨肥厚症是一种以韧带、肌腱等软组织及其附着部位的钙化和骨化为主要表现的全身性非炎症疾病,主要影响50岁以上的男性。研究表明肥胖症患者中弥漫性特发性骨肥厚症的发病率更高,但二者的因果关系尚不明确。目的:旨在通过孟德尔随机化分析方法,探讨肥胖症与弥漫性特发性骨肥厚症之间的因果关系。方法:研究选取全基因组关联研究数据库中的单核苷酸多态性作为工具变量,包括肥胖症和弥漫性特发性骨肥厚症相关数据。使用双向双样本孟德尔随机化分析方法评估肥胖症与弥漫性特发性骨肥厚症之间的因果关系,同时进行多效性、异质性和敏感性评价。结果与结论:孟德尔随机化分析发现肥胖症与弥漫性特发性骨肥厚症之间存在显著的正向因果关系。逆方差加权法显示“肥胖”(OR=1.111,95%CI:1.068-1.156,P=1.598×10^(-7))、“肥胖,热量过剩”(OR=1.093,95%CI:1.042-1.146,P=0.000)和“肥胖,其他/不详”(OR=1.109,95%CI:1.069-1.152,P=4.908×10^(-8))均与弥漫性特发性骨肥厚症显著相关。反向孟德尔随机化分析未发现弥漫性特发性骨肥厚症与肥胖症之间存在因果关系。多效性、异质性和敏感性检验结果验证了孟德尔随机化分析结果的可靠性。这表明肥胖症显著增加了弥漫性特发性骨肥厚症的风险,但弥漫性特发性骨肥厚症并不是肥胖症的危险因素。

Alkaline phosphatase flare with hyperostosis of bone metastases in lung adenocarcinoma treated with gefitinib

Alkaline phosphatase(ALP)flare has been reported to occur during cancer treatment as a favorable event,particularly in the presence of bone metastasis.There have been only a few reports in lung cancer and associated radiographic findings have seldom been described.The authors observed ALP flare in a female patient with lung adenocarcinoma soon after the initiation of gefitinib.Moreover,on computed tomography,metastatic lesions of the rib and thoracic spine showed marked hyperostosis,with sizes larger than the original bone structure,suggesting efficacy of gefitinib.The significance of such hyperostosis should be elucidated.

CT胸椎骨定量与冠脉及胸主动脉钙化相关研究

目的探讨常规CT中胸椎椎体骨质定量与冠脉及胸主动脉钙化相关性。方法收集217例患者一般资料、生化指标及冠脉CTA。测量冠脉、胸主动脉钙化积分,分为钙化组与非钙化组。测量T6~11椎体松质骨及皮质骨密度,椎体骨赘积分。进行组间比较、相关分析及回归分析。结果冠脉与胸主动脉钙化组年龄、收缩压、血糖及骨赘积分均高于非钙化组,松质骨密度低于非钙化组(P<0.05)。冠脉钙化积分与年龄、收缩压、血糖、皮质骨密度及骨赘积分正相关,与松质骨密度负相关(P<0.05)。胸主动脉钙化积分与年龄、收缩压及骨赘积分正相关,与松质骨密度负相关(P<0.05)。回归分析示年龄、收缩压、血糖及骨赘积分是冠脉钙化的独立风险因素,年龄、收缩压及骨赘积分是胸主动脉钙化的独立风险因素(P<0.05)。ROC曲线示联合应用各独立风险因素能提高对冠脉及胸主动脉钙化风险的预测价值。结论椎体骨赘积分增高和松质骨密度减低与冠脉及胸主动脉钙化显著相关。

弥漫性特发性骨肥厚症的危险因素分析

目的探讨弥漫性特发性骨肥厚症(DISH)的危险因素。方法对52例DISH患者的资料进行回顾性分析,并与200例有脊柱疾病的非DISH患者资料进行比较。对DISH相关危险因素进行单因素和多因素logistic回归分析。结果年龄、性别、体重指数(BMI)、空腹血糖、糖化血红蛋白、腹腔内脏脂肪面积、代谢综合征两组比较差异均有统计学意义(P<0.05)。将临床资料中有显著性差异的因素进行单因素logistic回归分析,结果表明,年龄、性别、BMI、代谢综合征、空腹血糖、糖化血红蛋白、腹腔内脏脂肪面积与发生DISH存在显著相关性(P<0.01)。进一步进行多因素logistic回归分析,结果表明,年龄≥60岁、男性、有代谢综合征、腹腔内脏脂肪面积相对大是DISH的独立危险因素。结论年龄≥60岁、男性、有代谢综合征、腹腔内脏脂肪面积相对大是DISH的独立危险因素。

中轴骨受累的SAPHO综合征患者临床及影像学分析

目的:探讨SAPHO综合征累及中轴骨患者临床及影像学表现,提高对此类疾病的认知率及诊断准确率。方法:回顾性分析42例(男16例,女26例)中轴骨受累SAPHO综合征患者的临床资料及影像学资料,总结临床特点、病变范围、部位、数目及骨质改变情况。结果:中轴骨受累患者主要临床表现为骨及关节症状(42例)及皮损表现(40例),26例有中轴骨症状(颈部、背部、腰骶部及下颌骨疼痛)。中轴骨累及包括脊柱(28例),骶髂关节(18例),颅面骨(5例);脊柱中胸椎受累比例(23例)及胸椎个数(47个)最多,23例表现为多椎体受累(病灶数≥2)。特征性影像征象:前胸壁骨显像“牛头征”,CT相邻椎体“接吻征”(5例),MRI椎体角呈圆弧形异常信号(6例),骶髂关节以单侧受累为主(12例),表现为骶髂关节炎性病变,部分骨质硬化,关节腔间隙存在;颅面骨以单侧下颌骨受累为主(4例),表现为骨质破坏改变。结论:SAPHO综合征累及中轴骨不少见,临床表现及影像学表现异质性较大,多模态影像学诊断可以提高对该疾病诊断效能。

司库奇尤单抗治疗滑膜炎-痤疮-脓疱病-骨肥厚-骨髓炎综合征1例并文献复习

目的总结司库奇尤单抗在滑膜炎-痤疮-脓疱病-骨肥厚-骨髓炎(SAPHO)综合征治疗中的应用经验。方法分析山西医科大学第一医院2021年7月收治的1例SAPHO综合征病人的临床资料。结果病人主诉右侧锁骨区肿痛7个月伴双手双足脓疱5个月,全身骨显像示“牛角征”,诊断:SAPHO综合征。给予皮下注射司库奇尤单抗,注射复方倍他米松1次,联合美洛昔康、甲氨蝶呤等口服药物,外用复方丙酸氯倍他索软膏治疗,40周后病情得到显著缓解。结论司库奇尤单抗治疗SAPHO综合征有效。

误诊为喉咽部肿物的食管型颈椎病1例

临床上食管型颈椎病较少见,部分患者表现为吞咽困难及咽部异物感,往往首诊于耳鼻咽喉科,查体可见喉咽部隆起,由于临床医师对该病认识不足,易导致误诊及漏诊,我科经治误诊为喉咽部肿物的食管型颈椎病1例,现报道如下。1临床资料患者,男,83岁,因咽部异物感10年,进行性吞咽困难2年就诊。患者诉10年前出现咽喉部异物感,

SAPHO综合征临床及影像学表现

目的 探讨滑膜炎、痤疮、脓疱疮、骨肥厚、骨炎综合征 (SAPHO综合征 )的临床和影像学表现。资料与方法 报道了 5例SAPHO综合征并复习文献。结果 SAPHO综合征有骨关节病变和皮肤病变。骨关节病变表现为骨肥厚、硬化和关节炎 ,好发部位是前上胸壁、脊柱、骨盆等 ,胸肋锁骨区的改变最有特征性。皮肤病变表现为脓疱疮和重症痤疮。结论 放射科医师应提高对SAPHO综合征的认识 ,并与其他疾病进行鉴别。

胸肋锁骨肥厚综合征临床影像学诊断

目的探讨胸肋锁骨肥厚综合征的影像学诊断与鉴别诊断。资料与方法回顾性分析6例患者的X线平片和CT平扫资料。6例中,3例行工作站图像后处理,3例行单光子计算机体层(SPECT)扫描。结果6例均为双侧性胸-肋-锁骨区受累骨增粗,骨、骨髓腔及肋软骨密度增高。相邻关节间隙消失,呈骨性融合。CT见右侧第1肋软骨处假骨折线。SPECT扫描示胸锁关节区双侧较对称的放射性核素浓聚。结论胸肋锁骨肥厚综合征具有较典型的影像学特征,结合临床可做出正确诊断。CT成像在显示受累骨骨皮质、髓腔、韧带骨化、关节骨性强直等方面的改变优于X线平片和SPECT。

中药配合物理疗法治疗膝关节骨质增生的疗效观察及护理

膝关节骨质增生为临床常见病、多发病,多发于中老年以上患者。临床以双膝关节剧烈疼痛、行走无力、活动受限、X检查示双膝关节骨质增生为特征。本病手术适应证要求较高,且效果不好,给治疗带来了很大的困难。2004~2009年我们运用中药内服辅以物理疗法治疗膝关节骨质增生182例,

SAPHO综合征1例

SAPHO综合征有皮肤病变和骨关节病变。皮肤特征性表现为掌跖脓疱病、脓疱型银屑病、聚合性痤疮等;骨关节病变表现为骨肥厚、硬化和关节炎。本例有掌跖脓疱病,脓疱性银屑病,双侧第一前肋增生肥厚,胸肋关节增生硬化。皮肤病理示银屑病改变,故确诊为SAPHO综合征。

35例难治性SAPHO综合征患者应用肿瘤坏死因子α拮抗剂的治疗随访

目的探讨肿瘤坏死因子α（TNF-α）拮抗剂治疗难治性SAPHO综合征（synovitis,acne,pustulosis,hyperostosisand and osteitis）的疗效及安全性。方法回顾分析35例难治性SAPHO综合征患者使用TNF-α拮抗剂治疗情况,记录患者治疗的反应。结果 35例患者应用TNF-α拮抗剂治疗时间为2～240周,平均（24.4±48.8）周。初期对骨痛有明显改善32例（91.4%）,其中接受1次治疗后骨痛有改善22例（68.8%）;接受2次治疗后骨痛改善8例（32.0%）;接受3次治疗后骨痛改善2例（6.2%）。初期对皮疹有效15例,但在维持治疗中因停药或减量皮疹复发或加重6例;对皮疹无改善12例;出现新发皮疹6例。出现不良反应9例：出现新发皮疹6例、出现颌下腺炎1例、出现臀部脓肿1例、出现肺炎1例。结论难治性SAPHO综合征患者接受TNF-α拮抗剂治疗,初期对骨痛有明显改善32例（91.4%）,多在前3次治疗中起效;但维持用药中只有11例（31.4%）有效;对皮疹的改善多不满意,只有9例（27.2%）有效,并且有可能诱发新发皮疹或皮疹加重,同时存在潜在感染的风险。

SAPHO综合征的诊断与治疗进展

SAPHO被定义为由滑膜炎、痤疮、脓疱病、骨肥厚、骨炎组成的综合征,是一种少见的累及皮肤和骨关节的慢性无菌性炎症。SAPHO综合征的临床特征表现多样化,影像学主要表现为骨肥厚和骨炎,诊断主要依靠其临床特征及影像学表现。新型生物制剂的使用及手术方式的改良为SAPHO综合征的治疗提供了新选择。