Some conditions may mimic DISH based on the presence of bony excrescences similar to those seen in the condition (). Spondylosis deformans and Ankylosing spondylitis are however the two conditions that are most similar to DISH. Spondylosis deformans is the commoner of the two. It can be differentiated from DISH based on the fact that it spares the anterior longitudinal ligament of the spine. Ankylosing spondylitis, on the other hand, is a relatively rare condition with an incidence of 0.05–1.4% as against DISH that has an incidence of 2.9–25% of the population., This condition is a chronic inflammatory rheumatoid disorder that characteristically affects young Caucasian males., In AS, the patients, usually have symptoms and also present with associated conditions like ulcerative colitis, iritis, oruveitis. Pathologically, there is the presence of sacroiliac and apophyseal joint fusion or sclerosis and sacroiliac joint inflammation. The earliest symptoms of these include back pain and stiffness. The inflammation progressively involves the intervertebral joints, leading to spondylitis, as well as the large peripheral joints including the knees, the hips, and the shoulders. The patient in very severe cases may after many years develop characteristic postural abnormalities like “Bechterew scoop”. The cause of AS is attributed to a combination of environmental and genetic factors which are still unknown. Research has however revealed the influence of several genes in the development of the disorder. The implicated genes include HLA-B27, ERAP1, IL1A, and IL23R., DISH, also known as Forestier disease, is a common disorder of unknown etiology characterized by enthesopathy of the spine and extremities, that usually presents with back pain and spinal stiffness. Diagnosis can be confirmed with radiographs of the cervical and thoracic spine., DISH is characterized by flowing ossifications along the anterolateral aspect of the spine, involving at least 3 consecutive vertebral levels or 4 contiguous vertebrae. Less commonly, peripheral enthesopathy may occur in the shoulders, elbows, knees, or calcaneus..