{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:56:33Z","timestamp":1777877793678,"version":"3.51.4"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"34","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8,22]]},"abstract":"<jats:sec>\n                    <jats:title>Rationale:<\/jats:title>\n                    <jats:p>Axial spondyloarthritis (axSpA) and diffuse idiopathic skeletal hyperostosis (DISH) exhibit substantial overlap in clinical symptoms and imaging features, frequently resulting in diagnostic errors. This case study delves into a patient initially misdiagnosed with axSpA but later confirmed to have DISH, aiming to dissect the root causes of misdiagnosis, identify critical diagnostic criteria, and devise strategies to enhance diagnostic accuracy between these 2 conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient concerns:<\/jats:title>\n                    <jats:p>The patient initially presented with chronic axial pain and stiffness, symptoms commonly associated with axSpA, leading to an initial misdiagnosis. This misdiagnosis raised concerns about the effectiveness of the prescribed treatment regimen and potential long-term implications for the patient\u2019s health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Diagnoses:<\/jats:title>\n                    <jats:p>The initial diagnosis of axSpA was based on the patient\u2019s symptoms and preliminary imaging results. However, through further in-depth investigation, including a comprehensive collection of clinical manifestations, more detailed imaging analysis, and multidisciplinary consultation, the final diagnosis was revised to DISH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>To rectify the misdiagnosis, strategies such as a more thorough gathering of patients\u2019 symptoms and signs, rational utilization of multiple auxiliary examinations (including advanced imaging techniques and laboratory tests), and collaboration with multiple disciplines (such as rheumatology, radiology, and orthopedics) were implemented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes:<\/jats:title>\n                    <jats:p>These interventions led to the accurate diagnosis of DISH, enabling the development of an appropriate treatment plan tailored to the patient\u2019s actual condition. As a result, the patient\u2019s symptoms were better managed, and the prognosis was improved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lessons:<\/jats:title>\n                    <jats:p>This case underscores the importance of recognizing the limitations of initial diagnostic approaches, overcoming cognitive biases and fixed thinking patterns among physicians, and the value of comprehensive, multidisciplinary evaluations. It provides valuable insights for clinicians to enhance their ability to distinguish between axSpA and DISH, thereby reducing the likelihood of misdiagnosis and improving overall diagnostic and treatment quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/md.0000000000044121","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T21:03:26Z","timestamp":1756847006000},"page":"e44121","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["A clinical case analysis of a misdiagnosis as AS, actually DISH: A case report"],"prefix":"10.1097","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3950-0321","authenticated-orcid":false,"given":"Shiwei","family":"Yuan","sequence":"first","affiliation":[{"name":"Department of Acupuncture, Longyan Hospital of Xiamen University, School of Medicine, Xiamen University, Longyan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuanhua","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Acupuncture, Longyan Hospital of Xiamen University, School of Medicine, Xiamen University, Longyan, China"},{"name":"Department of Rheumatology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuqing","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Acupuncture, Longyan Hospital of Xiamen University, School of Medicine, Xiamen University, Longyan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9106-2845","authenticated-orcid":false,"given":"Siyu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Acupuncture, Longyan Hospital of Xiamen University, School of Medicine, Xiamen University, Longyan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20260430","doi-asserted-by":"crossref","first-page":"101527","DOI":"10.1016\/j.berh.2020.101527","article-title":"Diffuse idiopathic skeletal hyperostosis: etiology and clinical relevance.","volume":"34","author":"Kuperus","year":"2020","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"R2-20260430","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1007\/s11914-023-00814-6","article-title":"Genetics of diffuse idiopathic skeletal hyperostosis and ossification of the spinal ligaments.","volume":"21","author":"Kato","year":"2023","journal-title":"Curr Osteoporos Rep"},{"key":"R3-20260430","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1148\/15.3.513","article-title":"Diffuse idiopathic skeletal hyperostosis (DISH): forestier\u2019s disease with extraspinal manifestations.","volume":"115","author":"Resnick","year":"1975","journal-title":"Radiology"},{"key":"R4-20260430","doi-asserted-by":"crossref","first-page":"563","DOI":"10.3390\/diagnostics13030563","article-title":"Imaging characteristics of diffuse idiopathic skeletal hyperostosis: more than just spinal bony bridges.","volume":"13","author":"Eshed","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"R5-20260430","first-page":"4680\u2009+\u20094707\u2009+\u20094737","article-title":"Analysis of 1 case misdiagnosed ankylosing spondylitis with diffuse idiopathic osteohypertrophy.","volume":"23","author":"Long","year":"2019","journal-title":"Prim Med Forum"},{"key":"R6-20260430","first-page":"645","article-title":"A case of diffuse idiopathic osteopathy misdiagnosed as ankylosing spondylitis.","volume":"47","author":"Shasha","year":"2016","journal-title":"New Med"},{"key":"R7-20260430","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1136\/annrheumdis-2016-210770","article-title":"2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis.","volume":"76","author":"van der Heijde","year":"2017","journal-title":"Ann Rheum Dis"},{"key":"R8-20260430","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.amsu.2020.11.028","article-title":"Diffuse idiopathic skeletal hyperostosis (DISH) with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine without neurological deficit \u2013 a case report.","volume":"60","author":"Anshori","year":"2020","journal-title":"Ann Med Surg (Lond)"},{"key":"R9-20260430","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1080\/03009747509095610","article-title":"The epidemiology of hyperostosis of the spine together with its symptoms and related mortality in a general population.","volume":"4","author":"Julkunen","year":"1975","journal-title":"Scand J Rheumatol"},{"key":"R10-20260430","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/0049-0172(78)90036-7","article-title":"Diffuse idiopathic skeletal hyperostosis (DISH) [ankylosing hyperostosis of Forestier and Rotes-Querol].","volume":"7","author":"Resnick","year":"1978","journal-title":"Semin Arthritis Rheum"},{"key":"R11-20260430","doi-asserted-by":"crossref","first-page":"bcr2014205446","DOI":"10.1136\/bcr-2014-205446","article-title":"AS, DISH or something else?","volume":"2014","author":"Naha","year":"2014","journal-title":"BMJ Case 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