Patients with diffuse idiopathic skeletal hyperostosis have an increased burden of thoracic aortic calcifications

N. Harlianto, J. Westerink, M. Hol, R. Wittenberg, W. Foppen, P. van der Veen, B. van Ginneken, J. Verlaan, P. de Jong, F. Mohamed Hoesein and UCC-SMART Study Group

Rheumatology Advances in Practice 2022;6(2):rkac060.


Objectives: DISH has been associated with increased coronary artery calcifications and incident ischaemic stroke. The formation of bone along the spine may share pathways with calcium deposition in the aorta. We hypothesized that patients with DISH have increased vascular calcifications. Therefore we aimed to investigate the presence and extent of DISH in relation to thoracic aortic calcification (TAC) severity.

Methods: This cross-sectional study included 4703 patients from the Second Manifestation of ARTerial disease cohort, consisting of patients with cardiovascular events or risk factors for cardiovascular disease. Chest radiographs were scored for DISH using the Resnick criteria. Different severities of TAC were scored arbitrarily from no TAC to mild, moderate or severe TAC. Using multivariate logistic regression, the associations between DISH and TAC were analysed with adjustments for age, sex, BMI, diabetes, smoking status, non-high-density lipoprotein cholesterol, cholesterol lowering drug usage, renal function and blood pressure.

Results: A total of 442 patients (9.4\%) had evidence of DISH and 1789 (38\%) patients had TAC. The prevalence of DISH increased from 6.6\% in the no TAC group to 10.8\% in the mild, 14.3\% in the moderate and 17.1\% in the severe TAC group. After adjustments, DISH was significantly associated with the presence of TAC [odds ratio (OR) 1.46 [95\% CI 1.17, 1.82)]. In multinomial analyses, DISH was associated with moderate TAC [OR 1.43 (95\% CI 1.06, 1.93)] and severe TAC [OR 1.67 (95\% CI 1.19, 2.36)].

Conclusions: Subjects with DISH have increased TACs, providing further evidence that patients with DISH have an increased burden of vascular calcifications.