What’s the connection with DHEA?
DISH/Multiple Exostoses
DISH (Diffuse Idiopathic Skeletal Hyperostosis) is a disease of the thoracic spine (the chest section of the backbone), which develops without inflammation, by hardening (calcification) of the ligaments which join the vertebrae together.
The underlying pathology of DISH was initially described by Forestier and Rotes-Querol in 1950, based on specimens and a series of 200 patients, referring to the condition as “senile ankylosing hyperostosis” (a much better name).
Recent studies have found a significant association between DISH and metabolic disorders, such as diabetes mellitus, hyperinsulinemia, obesity, dyslipidemia, and hyperuricemia/Gout.
The slow deposition of calcium in the ligaments between the vertebrae produces bony bridges which freeze the vertebrae together, preventing movement and producing an unmistakable x-ray image, which Portuguese physicians humorously, but accurately, call “biks de papagai”, because typically, the x-ray picture looks exactly like parrot (papagai) beaks.
Exostoses at muscle attachments, beside heavily-used joints
In DISH, Calcium deposition also occurs in the tissues around other heavily used joints, such as the elbows, knees and Achilles tendons, causing exostoses (bony growths, or “spurs”), at the point of attachment of tendons to bone.
The prevalence of DISH increases with every decade of life beyond 50 years. 15-25% of North Americans over the age of 50 years are affected and males are twice as liable to it, compared with females. However North Americans, on average, do not undertake sufficient heavy exercise to stress the tendons around the knees, ankles and elbows: so in many cases, limb-joint exostoses are absent, or too small to notice.
Since the early-morning back pain and stiffness of the DISH are relieved by stretching and mild exercise, affected men avoid visiting the doctor for as long as they can.
When they do attend the family physicians office, blood tests for inflammation are negative and physical examination discloses nothing, so both patient and physician blame the symptoms on “aging” and x-rays of the thoracic spine, which would show typical, obvious bony bridges between the vertebrae and thus provide a facile and instant diagnosis of DISH, are not ordered …………….. the diagnosis is missed.
Heberden’s Nodes
Heberden’s nodes, named for Dr. William Heberden, are small, paired, pea-sized bony growths that occur on the end (distal) -joints of the fingers. They are said to be due to osteoarthritis, but they often develop in the absence of any other osteoarthritic changes.
About 50% of women and 25% of men develop Heberden’s nodes by the age of 80–85 years and they are sometimes accompanied by “Bouchard’s nodes”, which are similar lumps, appearing on the Proximal (closer to the heart) finger joints.
Both Heberden’s and Bouchard’s nodes tended to be painful and tender when they are developing, but eventually the discomfort settles down. The fingers lose mobility and may “freeze” in a slightly “bent” position, causing reduced dexterity.
There is no effective treatment for Heberden’s and Bouchard’s nodes. Heat, splinting, exercises and physiotherapy have been tried, “NSAID” painkillers and steroids (including injections) have been prescribed; but generally, the nodes continue to develop.
Flexor tendon nodules and Dupuytren’s contracture
Small bumps, called “Notta’s nodules”, or simply “Flexor tendon nodules” sometimes develop on the tendons which pull the fingers into the “fist” position. The lumps are sometimeslocated just below the retention bands which hold the tendons close to the finger joints and when they do, the result is “trigger finger”.
They can also be located in the palm, where they don’t produce any tenderness or disability, but can be easily located on examination of the palm.
If It doesn’t produce a trigger finger, a Flexor tendon nodules is asymptomatic.
Dupuytren’s contracture
In this condition, the tendons stiffen and shorten, becoming tough cords that pull the fingers inward, so that the hand eventually assumes a “claw” position.
Treatment is as difficult (and commonly, as unsuccessful) as it is for Heberden’s nodes: steroid injections usually fail to solve the problem and in some cases, surgery is warranted.
What condition links Heberden’s nodes, Bouchard’s nodes, Palmar tendon nodules and Dupuytren’s contracture ?
I put this question to Chat GPT, which responded, noncommittally and unhelpfully, as follows:
“Heberden’s nodes, Bouchard’s nodes, palmar tendon nodules, and Dupuytren’s contracture are all conditions that cause abnormal growths or thickenings in the hands and fingers. They are all associated with connective tissue abnormalities and tend to develop with age” .…
In other words, chat GPT was unable to Identify a link.
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