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Title

FORESTIER SYNDROME: CASE REPORT AND BILIOGRAPHIC REVIEW

Background

Diffuse idiopathic skeletal hyperostosis (DISH), also called Forestier's disease, is characterized by calcification and ossification of axial or extra-axial sites. Its etiology is unknown, however, it is known to be associated with several comorbidities, such as osteoarthrosis, diabetes mellitus, dyslipidemia and hyperuricemia. It is important to mention that most patients are asymptomatic and the disease is discovered incidentally or in investigation of other symptoms. The main differential diagnoses are ankylosing spondylitis, which affects younger individuals and is more symptomatic, and spondylodiscartrose, in which traction osteophytes occur and there is no involvement of the anterior longitudinal ligament. There are no clinical guidelines developed for the treatment of DISH. The treatment is essentially symptomatic, aiming at the relief of pain and stiffness.

Case report

Patient A.D.C. Male patient, 77 years old, native of China and precedent of João Pessoa - PB, with arterial hypertension, diabetes mellitus type II and dyslipidemia. On the move since he was 30 years old due to chronic low back pain, pain in the cervical spine, a picture with a disabling history that stood out during the work and with the cold hours, although, it has improved when lying down. The patient in his evolution chose to prioritize alternative therapies such as chiropractic and acupuncture. During a complementary study, the patient was submitted to a simple cervical and dorsal radiograph in the postero-anterior position and profile in 2018. It was evidenced in the cervical disclassification by osteopenia, a discrete anterior osteophyte at C4, C5, C6 and C7 and extensive calcification in the anterior longitudinal ligament. Dorsal spine examination revealed demineralization of the dorsal spine due to osteopenia, diffuse marginal osteophytes and calcification in the diffuse anterior longitudinal ligament. The invertebrate space are preserved in both. The report's conclusion is a diffuse idiopathic skeletal disease (Forestier's disease). The exercise is not painful, does daily exercise of cervical stretching and revised to the lumbar spine, in addition, performs chiropractic every 3 months. Ethics comorbidities such as diabetes, hypertension and dyslipidemia. Using Metformin 850 mg, 500 mg losartan, 20 mg simvastatin, calcium, omega 3, 1 mg finasteride, doxasozine mesylate

Conclusion

We conclude that Forestier's disease causes a great dysfunction in the body's excavation, since there are physiotherapies which help in the stability of the disease.

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