Do you have severe back pain and stiff joints? This is the little-known condition that could be to blame… as DR SCURR reveals all the symptoms, causes and exactly how to treat it

I’ve suffered bouts of severe back pain for the last 20 years or so but have only recently been given a firm diagnosis – something called DISH. What is it, and can it be treated?

Tom Diamond, Tyne and Wear.

DISH stands for diffuse idiopathic skeletal hyperostosis and is a type of arthritis that causes bones to grow, forming spurs, at multiple sites around the body including the knees, shoulders and elbows, but particularly on the vertebrae (the bones that make up the spine).

This leads to the ligaments, which join bone to bone, becoming calcified and fixed.

The condition develops gradually and there is thought to be a genetic element to it, but a history of heavy manual work can be a contributory factor, as can exposure to fluoride and vitamin A, according to research (though it’s not clear why).

DISH is also more common in people who are overweight.

Patients often complain of pain in the back, neck or chest and there may be reduced flexibility.

Around 80 per cent of those affected experience a stiff spine in the morning, possibly because they’re immobile for some time overnight and joints are lubricated with movement.

Some also have problems swallowing because bone formation in the neck puts pressure on the upper part of the oesophagus, the tube that carries food from the throat to the stomach.

Physiotherapy is the primary treatment, helping by keeping patients mobile and promoting changes in the body’s chemistry that counter the processes that lead to spur formation.

Painkillers and anti-inflammatory drugs (such as ibuprofen) can also ease symptoms.

I’m slim, eat healthily and take a stroll most days – but I have high blood sugar (a reading of 42). This scenario is the same for several of my family and friends: all slim, active and fit, but with high blood sugar readings. I’m desperate to get mine down but am at a loss as to how.

Janet Mills, Bedford.

Dr Martin Scurr replies: This is a problem I’ve encountered before in patients, who are naturally concerned about high blood sugar readings, their risk of type 2 diabetes and the long-term risks associated with it, such as damage to eyesight, heart disease and shortened life span.

There’s the added anxiety that type 2 may not cause any symptoms until there’s irreversible damage to the blood vessels.

The figure you give – 42 – is a measure of the HbA1c (known as glycated haemoglobin), which is the average blood glucose over the past eight to 12 weeks.

Haemoglobin is the red pigment in blood cells; glucose (i.e. sugar) molecules stick to it and this so-called glycated haemoglobin is seen as a good measure of your average blood sugar ­levels over time. (Unlike with a standard blood test, which measures the sugar itself and provides a snapshot at that moment and can be affected by diet or exercise, for instance).

The normal range of HbA1c – i.e. non-diabetic – is 20 to 41. At 42, you are just (but only just) above that top level.

So why might levels be raised, given your healthy lifestyle?

High blood sugar in people with healthy lifestyles might be genetic but could be because after the age of 50 the body’s ability to produce insulin is reduced

This could be simply genetic, but also partly after the age of 50 your body’s ability to produce insulin is reduced, while the cells themselves become less responsive to the hormone, leading to higher glucose levels.

Also, you say in your longer letter that you have been prescribed statins for high cholesterol since 2023. Statins slightly increase the chance of developing type 2 diabetes (via a similar mechanism as ageing), although the evidence is that this is only a risk if you have other risk factors such as a higher baseline glucose level or obesity. It’s fair to say the risk from statins is very small, and it is beyond doubt that the cardiovascular protection they give far outweighs this.

As for what you could do to reduce your level, it’s so close to the normal range that in my view, sticking to your good diet and lifestyle should protect you against type 2 diabetes.

For readers with higher readings, exercise, eating healthily and losing weight is the mantra.

In my view… New drug to help depressed patients

Fewer than 5 per cent of patients with depression are referred to psychiatrists – 90 per cent of antidepressant prescribing is by GPs. Unfortunately, we know that the drugs don’t work for many.

Typically, if a patient fails to respond, a second drug is added or they’re swapped to a different antidepressant. But that has an even lower remission rate than with the first drug: basically, adding new drugs leads us into a law of diminishing returns.

Now, however, pramipexole, a drug used to treat Parkinson’s disease, has been shown to enhance the benefit of antidepressant medication when given alongside it – with a response rate three times higher than if the patient was given the antidepressant with a placebo.

Given how difficult it is for GPs to access psychiatric care for their patients – or even cognitive behavioural therapy in many cases – this is a good treatment option for doctors. I hope new guidelines will reflect this.

• Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY, or email: drmartin@dailymail. co.uk. Replies should be taken in a general context. Always consult your own GP with any health concerns.