Forestiers Disease: Causes, Symptoms & Treatment

Forestier’s disease is a disease of the skeleton, which is associated with an increasing stiffening of the spine. Treatment options nowadays allow for a positive course of the disease; severe courses are extremely rare.

What is Forestier disease?

Forestier disease is a systemic, noninflammatory skeletal disorder. It is named after the French internist Jacques Forestier, who described it as “aged stiffening hyperostosis of the spine.” Typical of the disease is 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, although the lower extremities are also damaged. The cause of Forestier’s disease can be traced to genes, although the actual onset can be favored by various conditions such as gout or diabetes. Therapeutic measures are also complex. They range from surgery to the administration of medication to heat therapy and gymnastics. The possible preventive measures are similarly extensive, although an outbreak can never be completely prevented with appropriate facilities.

Causes

The possible causes of Forestier disease are numerous. For example, a striking number of patients have underlying conditions such as circulatory and lipid metabolic disorders, gout, or diabetes. General restrictions in mobility, such as those that can occur when the patient is bedridden, are also a possible trigger. The same applies to lack of 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 of certain drugs and substances can also trigger the disease. First and foremost, fluorides, vitamin A (retinol) and retinoids as used in therapy. Isotretinoin and acitretin in particular can lead to Forestier’s disease in conjunction with certain metabolic conditions. In addition, however, the disease can also occur independently and without any recognizable triggers. Because of the variety of possible causes, diagnosis is usually based on symptoms.

Symptoms, complaints, and signs

Forestier disease is associated with some distinct symptoms. These primarily include back pain and lower extremity pain. The symptoms may radiate down the legs and are accompanied by other symptoms such as tendon insertion pain around the kneecap. Often the heels are also affected or there is stiffness in the back and limbs. As the disease progresses, the spine stiffens, which can lead to other symptoms. Difficulty swallowing is another sign of Forestier’s disease, but can only be clearly attributed to the disease in conjunction with other symptoms. These are mainly pains in the back and legs, which are only mild at first, but increase sharply within a very short time. Rapid diagnosis and treatment are therefore essential.

Diagnosis and course of the disease

Forestier disease is diagnosed by several measures. First, a comprehensive medical history is taken with the patient to determine the exact symptoms and their severity. It is also clarified within this conversation whether previous illnesses are present and whether similar complaints have occurred 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 taken and evaluated on the basis of the so-called Resnick criteria. In this way, it is checked whether the bone material has a right-sided coating, which is a clear indication of Forestier’s disease. Within the differential diagnosis, other diseases are excluded by further examinations. The course of the disease is positive if treated early. If the therapeutic measures are initiated quickly, no severe course is to be expected, although permanent consequential damage is not uncommon. Stiff limbs, problems with the vertebrae or, in severe cases, paralysis of the back can occur. Early treatment prevents these consequential damages in most cases.

Complications

In most cases, Forestier disease does not develop any particular complications or become severe. The disease can be relatively well limited with various therapies, so that the everyday life of the affected person is not restricted. Patients primarily suffer from severe pain in the back as a result of the disease. This pain can also radiate to other regions of the body and cause discomfort there. Likewise, pain at rest can occur at night, affecting sleep and leading to sleep disturbances or depression. The patient’s quality of life is significantly reduced and limited by Forestier’s disease. Furthermore, swallowing difficulties may also limit the intake of food and fluids, resulting in malnutrition or dehydration. Treatment of this disease can be done with the help of medications and through therapies. Complications do not occur. Usually, most of the symptoms and pain can be limited, although patients are dependent on lifelong treatment. However, life expectancy is not reduced by Forestier disease.

When should you see a doctor?

In Forestier’s disease of the skeleton, the first pain and stiffness in the lower back usually trigger a visit to the doctor. The predisposition to this disease is often genetic. However, Forestier’s disease can also be triggered in other ways. Those affected experience symptoms at a relatively young age, which medical professionals normally associate with old age. The sooner the first visit to the doctor for Forestier’s disease is made, the better the therapy can take effect. If the predisposition to this disease is already known in the family, certain preventive measures can even be taken. However, this does not mean that an outbreak of Forestier’s disease can be reliably prevented. If the stiffening of the spine has already begun, the attending physicians can only alleviate and limit the symptoms through heat treatments, exercise therapy, pain-relieving medication or, if necessary, surgery. People affected by Forestier’s disease must expect to undergo treatment and regular follow-up examinations for many years. An early visit to the doctor is also advisable because Forestier’s disease is often accompanied by concomitant diseases such as diabetes, lipometabolic disorders or circulatory disorders. In addition, the symptoms that occur – such as back pain radiating into the legs or swallowing difficulties – could also indicate other diseases. In order to exclude these, the earliest possible visit to the doctor is advised.

Treatment and therapy

Forestier’s disease cannot be treated causally to date. Therapy therefore focuses on symptomatic treatment with the help of painkillers – strong analgesics are mainly administered in Forestier’s disease – anti-inflammatories and other medications. In addition, heat applications and massages can be performed to relieve muscle tension and make the muscles and joints more flexible. Physiotherapy also serves this purpose and helps prevent functional impairment. Depending on the severity of the disease, the above-mentioned measures can also be used to restore limited bodily functions. In general, the treatment of Forestier’s disease is a long-term therapy that is never completely finished. Affected individuals are usually in treatment until the end of their lives and must expect a considerable reduction in quality of life despite comprehensive therapy measures.

Outlook and prognosis

Forestier disease allows a mixed prognosis. It appears problematic that the actual cause cannot be treated. Therapy is aimed at maintaining mobility. Physiotherapy is usually prescribed to prevent stiffening of the spine. Building up muscles also seems to promise success. The success of such therapy is strongly dependent on the self-motivation of the affected person. Ultimately, however, it cannot be ruled out that the quality of life will suffer. A shortening of the life span is not to be expected in principle by the Morbus Forestier. The disease occurs in five out of one hundred patients in Europe, according to studies. The group of senior citizens is particularly affected. In principle, the risk of contracting Forestier’s disease increases with age.In a comparison of both sexes, men suffer from the typical symptoms conspicuously often. Other underlying diseases such as diabetes and a lipometabolic disorder increase the risk of Forestier’s disease. Without treatment, the symptoms multiply. The disease can then cause considerable immobility of the spine, making it impossible to perform everyday activities. Even swallowing difficulties are caused by it.

Prevention

Prevention of Forestier’s disease is limited to mentioned muscle building exercises. Progressive muscle relaxation according to Jacobson is 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. This can prevent underlying conditions such as diabetes or gout, which can accelerate the onset of the disease. Special care should be taken when taking certain medications that contain the substances mentioned. Lastly, at-risk groups should get regular checkups and have a comprehensive diagnosis made as soon as the first symptoms appear.

Follow-up

It is imperative that people diagnosed with Forestier’s disease maintain adequate warmth of the skeletal and muscular systems to stabilize their overall organism. Any exposure to cold should therefore be avoided. Wearing appropriate clothing and taking warming baths can help alleviate discomfort. The entire musculoskeletal system must be permanently exercised. Appropriate exercises can be learned in accompanying physiotherapy and implemented independently. The general well-being of the patient must be improved and strengthened. Regular training sessions are essential for this. A healthy lifestyle with sufficient sleep and a balanced diet should be a matter of course. To maintain general vitality, harmful substances such as alcohol and nicotine should be avoided at all costs. Forestier’s disease cannot yet be cured causally. The consequence for the affected person is a long-term therapy until the end of his life. The mental condition of the patient plays an important role in this disease. With a stable psyche, everyday life with Forestier’s disease can be better mastered. Mental strengthening is provided by relaxation techniques that help reduce stress and thus build up the patient’s inner balance. In self-help groups and special Internet forums, patients can exchange information with other sufferers. There they receive targeted assistance and individual tips for dealing with this disease in everyday life.

What you can do yourself

Sufferers of Forestier’s disease can strengthen and stabilize their organism by ensuring themselves that the skeletal and muscular systems receive sufficient heat. Drafts and exposure to cold should be avoided. Warming baths as well as wearing appropriate clothing are helpful in alleviating existing complaints. In addition, the musculoskeletal system should be exercised daily despite all adversities. Special exercises to support the body can be learned in physiotherapy and then implemented independently. Regular training sessions are necessary to improve well-being and reduce existing complaints. Vitality is to be promoted by 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, mental strength should 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 to build up the inner balance. In addition, therapeutic treatments can be used so that the developments and the course of the disease can be well processed. In an exchange with other sufferers, communication can be established in self-help groups or special Internet forums. This provides assistance and individual tips for everyday life.