The Frequency of Diffuse Idiopathic Skeletal Hyperostosis (DISH) in Spondyloarthritis in Comparison to Age and Sex-Matched Controls and Impact of SpA on Onset Age of DISH
Bibliographic record
Abstract
Objectives Although diffuse idiopathic skeletal hyperostosis (DISH) is classically defined in the thoracic spine and the elderly population, there are case reports on the overlap between cervical DISH and spondyloarthritis (SpA).[1] We aimed to compare the frequency of cervical DISH in SpA vs controls to see whether there is a true increased frequency and if the presence of SpA impacts the onset age of DISH. Methods The SpA population included patients who were diagnosed with axial or peripheral SpA, followed at the Arthritis Centre and had cervical spine x-rays for screening purposes between 2016-2020. The control group included patients who presented to the Emergency Department and had a cervical spine x-ray for any reason. Four control patients for each SpA patient were age- and sex-matched. An investigator meeting on the definitions took place before the study, followed by an agreement exercise. Two radiologists independently scored the radiographs for the confidence level for the presence of DISH on a scale between 0-5. The ICC of the 2 radiologists were 0,935. For the study, the radiographs were read by 1 of the 2 radiologists, who distributed the cases and controls equally among the 2 radiologists. The confidence of Grade 3 was considered as DISH positive. Results One-hundred-ninety-one SpA and 764 age- and sex-matched controls were included (Table). DISH was observed in 26 (13.6%) SpA patients and 108 (14.1%) controls, with similar frequencies (p=0.852). The age of DISH+ patients was statistically significantly lower in the SpA group than the control group (median (IQR); 54 (16) vs 59 (13); p=0.026). DISH was higher in males than females in both SpA (n:19/104 (18.3%) vs n:7/87 (8%); p=0.04) and control groups (n:74/416 (17.5%) vs n:35/348 (10.1%); p=0.003). There were 143 (74.9%) SpA patients with known HLA-B27 status. The frequency of DISH in HLA-B27(−) SpA patients was higher than HLA-B27(+) SpA patients numerically (n=14/65 (21.5%) vs n=8/78 (10.3%); p=0.063). Interestingly, HLA-B27 had different effects on the presence of DISH in subgroups: AxSpA patients (radiographic and non-radiographic combined) had more DISH if they were HLA-B27 positive (12.5% vs 8.7%), unlike the PsA, who had DISH exclusively if they were HLA-B27 negative (28.2% vs 0%). Table. Demographics and disease subgroups Conclusion The frequency of DISH in SpA patients is similar to the general population. However, SpA patients develop DISH at an earlier age. Our observation of the differential impact of HLA-B27 on axSpA vs PsA may signal the different mechanisms impacting the spine in both diseases. [1.] Kuperus JS. Rheumatology (Oxford) 2018;57(12):2120-8.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".