Fig. (1) Growth factors present in patients with DISH, such as growth hormone, insulin or insulin-like growth factor, target the chondrocytes
and mesenchymal cells in the uncalcified portion of the enthesis. Proliferation of these cell types results in new bone formation. The
components of the enthesis are detailed in the diagram to the right. Molecular mechanisms within the entheseal cells have been recently
summarized [92].