title: Nonarticular tenderness and functional status in patients with diffuse idiopathic skeletal hyperostosis.
abstract: OBJECTIVE
  To investigate the degree of nonarticular tenderness and functional status in patients with diffuse idiopathic skeletal hyperostosis (DISH). We assessed these variables' correlation with their clinical, radiographic, and constitutional measurements and with metabolic syndrome (MS).
  
  
  METHODS
  Eighty-seven patients with DISH were compared with 65 controls without DISH. Examination of nonarticular tenderness was performed by thumb palpation. Tenderness was scored for the 18 fibromyalgia tender points (TP), and 4 control points. Nonarticular tenderness was expressed by the number of TP and by the total tenderness score (TTS). The Short Health Assessment Questionnaire (HAQ II) was administered to all participants. Clinical and laboratory data were collected from all patients. Patients were classified as having MS by both the National Cholesterol Education Program and World Health Organization definitions.
  
  
  RESULTS
  There was a statistically significant difference in TTS between controls and patients with DISH. The mean tenderness of many individual TP was significantly higher in the DISH group compared with the control group. TP counts, TTS, and body mass index (BMI) positively correlated with the HAQ II. There was a linear trend in intensity of T-spine bony bridges (BB) and the total number of TP as well as many individual TP. Patients with DISH were more likely to be affected by MS. No correlation was found between TP count, TTS, and MS.
  
  
  CONCLUSIONS
  Patients with DISH have a lower pain threshold than patients who do not have DISH. TP count and TTS correlate with the functional status, BMI, waist circumference, and high-grade BB. No correlation was observed between pain threshold and MS.
authors.affiliation: Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula 18101, Israel. Mader_r@clalit.org.il
authors.forename: Reuven
authors.initials: R
authors.lastname: Mader
authors.forename: Irina
authors.initials: I
authors.lastname: Novofastovski
authors.forename: Ehud
authors.initials: E
authors.lastname: Rosner
authors.forename: Muhammad
authors.initials: M
authors.lastname: Adawi
authors.forename: Paula
authors.initials: P
authors.lastname: Herer
authors.forename: Dan
authors.initials: D
authors.lastname: Buskila
mesh_terms: D000203:Activities of Daily Living; D005356:Fibromyalgia / Q000503:physiopathology; D006801:Humans; D004057:Hyperostosis, Diffuse Idiopathic Skeletal / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D017288:Pain Threshold; D010173:Palpation; D011795:Surveys and Questionnaires