Forestier’s disease, a little-known yet common bone disease

Forestier's disease, a little-known yet common bone disease

Forestier and Rotès-Querol disease, also called ankylosing vertebral hyperostosis, is a benign and common joint disease, particularly in men over 50, indicates Professor Pierre Lafforgue, rheumatologist at Sainte-Marguerite hospital in Marseille (Assistance Publique -Hospitals of Marseille, AP-HM). Let’s discover the causes, symptoms and treatment of this form of arthritis, too often confused with other rheumatological pathologies.

What is Forestier’s disease or ankylosing spinal hyperostosis?

A disease discovered by a French doctor, Dr. Jacques Forestier

Forestier’s disease, or Forestier and Rotès-Querol disease, was described in 1950 by Dr. Jacques Forestier, a French doctor and great pioneer of rheumatology in Europe, and by Dr. Rotès-Querol, a Spanish rheumatologist. This joint disease is, however, much older since signs of it were found in ancient Egypt, notably on the skeleton of Ramses II, specifies Professor Pierre Lafforgue, rheumatologist at Sainte-Marguerite hospital in Marseille (Assistance Publique -Hospitals of Marseille, AP-HM).

Fabrication of bone bridges

Referred to by the medical termankylosing vertebral hyperostosisForestier’s disease is a rheumatological disease which mainly affects the spine and which, unlike other forms of arthritis, does not cause inflammation. It corresponds to a calcification areas of insertion of tendons and ligaments on bones. “This disease is characterized by the production of bony bridges at the level of the entheses which are the areas of attachment to the bone of the ligaments, tendons and the joint capsule”, explains the rheumatologist. “This ossification process mainly affects the spine, therefore the vertebrae, at the dorsal and cervical level, but it can affect all bony structures.. Various joints can therefore present this phenomenon of hyperostosis: the joints of the hips, elbow, knee, ankle, etc.

Is Forestier’s disease hereditary? Is it serious?

Forestier’s disease is far from being a rare disease. According to the specialist, it is on the contrary a very common disease which affects between 12 and 25% of men after the age of 50. “Men are more affected than women by Forestier’s disease – they represent ¾ of cases – without knowing exactly why.

Very rare before the age of 50, its prevalence increases exponentially with age. And Professor Lafforgue wants to be reassuring: it is neither a hereditary disease nor a serious illness.

What are the causes of Forestier’s disease?

We do not know the exact cause of Forestier’s disease. On the other hand, specialists have observed a strong association with metabolic syndrome which combines, among other things, overweight or obesity, type 2 diabetes and high blood pressure.

What are the symptoms of Forestier’s disease?

A disease that is often asymptomatic

Forestier and Rotès-Querol disease is most often asymptomatic and discovered incidentally during an x-ray. “Only a minority of patients with ankylosing vertebral hyperostosis consult specifically for this.underlines Professor Lafforgue.

Pain and stiffness, characteristic symptoms

When Forestier’s disease is symptomatic, its main symptoms are pain at the level of the back as well as progressive ankylosis of the column manifested by stiffness. People affected by Forestier’s disease may experience severe painful attacks, similar to tendinitis and located around the joints of the arms and legs. Symptoms often attributed to aging and considered “normal”, or wrongly attributed to other rheumatological diseases, notably osteoarthritis.

What are the complications of Forestier’s disease?

Unlike severe osteoarthritis, Forestier and Rotès-Querol disease is a benign disease which will never be disabling, reassures the rheumatologist. However, sometimes complications can arise and lead to more serious symptoms when the bony protrusions affect the surrounding tissues.

Compression of other organs

“LComplications are exceptional”, insists the rheumatologist. “It happens, however, that the exuberant bone production at the level of the cervical spine leads to compression of the esophagus, larynx and trachea, causing difficulty in swallowing, breathing or breathing. talk”.

Increased risk of fractures

People with ankylosing spinal hyperostosis are also at increased risk of fractures. “Bone bridges, by stiffening the spine, can also increase the risk of cracks and fractures.confirms the doctor. But this remains very rare.”.

How to diagnose Forestier’s disease?

Radiography, the main imaging test

The diagnosis of Forestier’s disease is based on clinical examination and analysis of the patient’s symptoms. It must then be confirmed by a medical imaging examination, more precisely an x-ray of the spine, from the cervical to the sacroiliac region via the dorsal region. The diagnosis is confirmed when the image shows the presence of bony bridges characteristic of this condition on at least 4 vertebrae. Other imaging tests (such as CT or MRI) are of no interest, except to diagnose complications of the disease.

As ankylosing vertebral hyperostosis does not cause any changes likely to be detectable in the urine or blood, biological tests are useless.

Forestier’s disease, often confused with osteoarthritis or ankylosing spondylitis

The diagnosis of ankylosing vertebral hyperostosis nevertheless remains very often incorrect, often confused with that of osteoarthritis or ankylosing spondylitis. “Forestier’s disease is very often confused with osteoarthritis because it affects the same population – people over 50 who have back pain – or with ankylosing spondylitis. In addition, the appearance on the x-ray is quite similar to that of these two pathologies. What can help in the diagnosis of Forestier and Rotès-Querol disease is the predominance of bony bridges on the right side of the body, underlines Professor Lafforgue. “The hypothesis to explain this laterality is that the beating of the aorta would prevent ossification on the left side..

How to treat Forestier’s disease?

How to treat Forestier’s disease? Who to consult?

Currently, there is no no treatment capable of curing Forestier and Rotès-Quérol disease. Patients should consult their general practitioner who, if they suspect ankylosing vertebral hyperostosis, may order an x-ray. Once the diagnosis is confirmed, the treatment is multidisciplinary and aims above all to reduce pain and improve the quality of life of patients. It can combine drug treatment, manual or functional therapies, the practice of physical exercises and, as a last resort, surgery.

Physical exercises at the heart of treatment

Patient care is mainly aimed at relieving associated pain. “The best treatment for ankylosing spinal hyperostosis is movement. It is recommended to have regular physical activity. For people who find it difficult to be active, physiotherapy sessions can be useful.”advises Professor Lafforgue.

Pain medication if needed

“If the pain is too severe, anti-inflammatories and analgesics can be prescribed on demand. On the other hand, infiltrations are rarely necessary”, continues the rheumatologist. What about thermal cures? “”There is no scientific proof of their benefit in Forestier’s disease, however some patients say they are relieved, so why not?s”.

Is surgery indicated?

On its website, the Arthritis Society Canada only offers surgery as a last resort and only in cases where Forestier’s disease has progressed to a point where it causes complications, “for example the development of large bone spurs that affect important tissues such as the trachea, spinal cord or blood vessels. In such cases, the surgeon might remove the bone spurs – which will not cure the condition“, she explains.