Forestier's disease

As Forestier's disease is a disease of the skeleton, which is associated with an increasing stiffening of the spine. The treatment options nowadays allow a positive course of the disease; severe forms are extremely rare.

What is Forestier's disease?

Forestier's disease is a systemic, non-inflammatory skeletal disease. It is named after the French internist Jacques Forestier, who described it as "old age stiffening hyperostosis of the spine". Typical for the disease is an ossification of the entheses, i.e. the points on the bone that connect to a joint capsule, a ligament or a tendon.

The spine is mainly affected, and the lower extremities are also damaged. The cause of the development of Forestier's disease can be traced back to the genes, whereby the actual outbreak can be favored by various ailments such as gout or diabetes. The therapeutic measures are also complex.

They range from operations to the administration of drugs to heat therapy and gymnastics. The possible preventive measures are similarly extensive, although an outbreak can never be completely prevented with appropriate systems.

causes

The possible causes for the development of Forestier's disease are numerous. A noticeable number of patients have underlying diseases such as circulatory and lipid metabolism disorders, gout or diabetes. General restrictions on mobility, such as those that can occur when bedridden, for example, are also a possible trigger. There is also little exercise, weak muscles and a generally unhealthy lifestyle.

However, it is difficult to clearly assign the possible causes, which is why the treatment of Forestier's disease focuses on the symptoms. In addition, it is now assumed that genetic factors and interactions between certain drugs and substances can also trigger the disease. Above all, fluorides, vitamin A (retinol) and retinoids, as used in therapy.

Isotretinoin and acitretin in particular can lead to Forestier's disease in connection with certain metabolic conditions. In addition, the disease can also occur independently and without a recognizable trigger. Due to the multitude of possible causes, the diagnosis is usually based on symptoms.

Symptoms, ailments & signs

Forestier's disease has some clear symptoms. These primarily include back pain and pain in the lower extremities. The complaints can extend to the legs and are accompanied by other symptoms such as tendon attachment pain in the kneecap area. Often the heels are also affected, or the back and limbs become stiff.

As the disease progresses, the spine stiffens, which can lead to further symptoms. Difficulty swallowing is another sign of Forestier's disease, but can only be clearly traced back to the disease in conjunction with other symptoms. These are mainly pain in the back and legs, which are only weak at first, but increase sharply within a very short time. Rapid diagnosis and treatment is therefore essential.

Diagnosis & course of disease

Forestier's disease is diagnosed through various measures. First, a comprehensive anamnesis is carried out with the patient in order to determine the exact symptoms and their severity. This conversation also clarifies whether there are any previous illnesses and whether there have been similar complaints within the family in the past.

In this way, the doctor can get an initial picture and then make the exact diagnosis. For this purpose, x-rays are made and evaluated using the so-called Resnick criteria. This checks whether the bone material has a coating on the right side, which is a clear indication of Forestier's disease. Other diseases are excluded by further examinations within the differential diagnosis.

The course of the disease is positive with early treatment. If the therapeutic measures are initiated quickly, no severe forms are to be expected, whereby permanent consequential damage is not uncommon. This can lead to stiff limbs, problems with the vertebrae or, in severe cases, paralysis of the back. In most cases, early treatment prevents these consequential damages.

Complications

In most cases, Forestier's disease does not have any particular complications or serious courses. The disease can be limited relatively well with various therapies, so that the everyday life of those affected is not restricted. The patients suffer primarily from severe back pain as a result of the disease. This pain can also radiate to other regions of the body and lead to discomfort there.

Resting pain can also occur during the night, which impair sleep and can lead to sleep problems or depression. The patient's quality of life is significantly reduced and restricted by Forestier's disease. Difficulty swallowing can also limit the intake of food and fluids, leading to malnutrition or dehydration.

Treatment of this disease can be carried out with the help of drugs and therapies. There are no complications. As a rule, most of the symptoms and pain can be limited, although the patients are dependent on lifelong treatment. However, Forestier's disease does not reduce life expectancy.

When should you go to the doctor?

In the case of the skeletal disease Forestier's disease, the first pain and stiffness in the lower back usually trigger a visit to the doctor. The disposition to this disease is often genetic. Forestier's disease can also be triggered differently. Those affected experience symptoms at a relatively young age that medical professionals normally associate with old age.

The sooner the first visit to the doctor for Forestier's disease occurs, the better the therapy can be effective. If the family's predisposition to this disease is already known, certain precautionary measures can even be taken. However, this does not mean that an outbreak of Forestier's disease can be safely prevented. If the spine has already started to stiffen, the treating doctors can only alleviate and limit the symptoms through heat treatments, exercise therapy, pain-relieving medication or, if necessary, an operation.

People affected by Forestier's disease must expect treatment and regular follow-up examinations for many years. An early visit to the doctor is also advisable because Forestier's disease often has accompanying diseases such as diabetes, lipid metabolism disorders or circulatory disorders. In addition, the symptoms - such as back pain radiating into the legs or difficulty swallowing - could also indicate other diseases. To rule out this, it is advisable to see a doctor as early as possible.

Therapy & Treatment

Forestier's disease cannot yet be treated causally. Therapy therefore focuses on symptomatic treatment with the help of painkillers - strong analgesics are mainly administered for Forestier's disease -, anti-inflammatory drugs and other drugs.

In addition, heat applications and massages can be performed to relieve muscle tension and make muscles and joints more flexible. Physiotherapy also serves this purpose and helps to avoid functional impairments. Depending on the severity of the disease, the measures mentioned can also be used to strengthen restricted body functions again.

In general, the treatment of Forestier's disease is a long-term therapy that is never fully completed. Those affected are usually treated for the rest of their lives and, despite extensive therapeutic measures, have to expect a considerable reduction in quality of life.

Outlook & forecast

Forestier's disease allows for a mixed prognosis. It appears problematic that the actual cause cannot be treated. The therapy aims to maintain mobility. Physiotherapy is usually prescribed to prevent the spine from stiffening. Building muscles also seems to promise success. The success of such a therapy depends heavily on the self-motivation of the person concerned.Ultimately, however, it cannot be ruled out that the quality of life will suffer. A shortening of the lifespan is generally not to be expected due to Forestier's disease.

The disease occurs in five out of one hundred patients in Europe; so studies prove it. The group of senior citizens is particularly affected. Basically, the risk of developing Forestier's disease increases with age. When comparing the two sexes, it is noticeable that men often suffer from the typical symptoms. Other underlying diseases such as diabetes and a lipid metabolism disorder increase the risk of Forestier's disease.

Without treatment, the symptoms increase. The disease can then cause a considerable immobility of the spine, which no longer allows everyday activities to be carried out. They even cause difficulty swallowing.

prevention

The prevention of Forestier's disease is limited to the aforementioned exercises to build muscle. Jacobson's progressive muscle relaxation is just as effective as autogenic training and can help prevent the disease. In addition, a healthy lifestyle with sufficient exercise and a healthy diet should be maintained.

In this way, basic ailments such as diabetes or gout, which can accelerate the onset of the disease, can be avoided. Particular caution is required when taking certain medications that contain the substances mentioned. Finally, risk groups should have themselves checked regularly and a comprehensive diagnosis made as soon as the first symptoms appear.

Aftercare

People diagnosed with Forestier's disease must ensure that the skeletal and muscular systems are supplied with sufficient heat in order to stabilize their organism as a whole. Any exposure to the cold should therefore be avoided. Wearing appropriate clothing and warming baths can help alleviate discomfort. The entire musculoskeletal system must be permanently trained.

Corresponding exercises can be learned in accompanying physiotherapy and implemented independently. The general well-being of the sick person needs to be improved and strengthened. Regular training sessions are essential for this. A healthy lifestyle with enough sleep and a balanced diet should go without saying. In order to maintain general vitality, pollutants such as alcohol and nicotine must be avoided.

Forestier's disease cannot yet be cured. The result for those affected is long-term therapy until the end of their life. The mental state of the patient plays an important role in this disease. With a stable psyche, everyday life with Forestier's disease can be better mastered.

Relaxation techniques that help reduce stress and thus build up the patient's inner balance provide mental strengthening. In self-help groups and special internet forums, sick people can exchange ideas with other affected persons. There you will receive specific help and individual tips for dealing with this disease in everyday life.

You can do that yourself

Sufferers of Forestier's disease can strengthen and stabilize their organism by ensuring that the skeletal and muscular systems are adequately supplied with heat. Avoid drafts and the effects of cold. Warming baths and wearing appropriate clothing are helpful in relieving existing discomfort.

In addition, the musculoskeletal system should be trained daily despite all adversities. Special exercises to support the body can be learned in physiotherapy and then implemented independently. Regular training units are necessary to improve well-being and to reduce existing complaints.

Vitality is to be promoted through a healthy lifestyle and a balanced diet. The consumption of harmful substances such as nicotine or alcohol should be avoided. Since the diagnosis of Forestier's disease results in long-term therapy until the end of life, the mental strength must be strengthened. Dealing with the disease in everyday life is more successful when the psyche is stable and healthy. Different relaxation techniques help to reduce existing stressors and build inner balance.

In addition, therapeutic treatments can be used so that developments and the course of the disease can be processed properly. In an exchange with other sick people, communication can be established in self-help groups or special internet forums. This provides assistance and individual tips for everyday life.