title: Early-onset osteoarthritis due to otospondylomegaepiphyseal dysplasia in a family with a novel splicing mutation of the COL11A2 gene.
abstract: OBJECTIVE
  To evaluate an approach to the clinical, radiographic, and molecular diagnosis of an underlying skeletal dysplasia in adults presenting with early-onset polyarticular osteoarthritis (OA).
  
  
  METHODS
  We identified a family with 2 adults with polyarticular OA and a child with generalized arthralgia. General, musculoskeletal, ocular, and auditory evaluations were undertaken. Investigations included radiographs of symptomatic joints, analysis of serum inflammatory markers and joint fluid, and mutational analyses of the COL11A2 gene.
  
  
  RESULTS
  The 3 affected individuals had normal stature, mild mid-face hypoplasia, and hearing impairment, but normal eyes. Radiographs of the affected adults showed severe polyarticular OA but did not reveal diagnostic evidence of an underlying skeletal dysplasia. However, the child's radiographs showed enlarged epiphyses with an advanced bone age. The combination of skeletal, facial, and auditory features together with the absence of ocular features indicated that they had otospondylomegaepiphyseal dysplasia, also known as Stickler syndrome type III. The diagnosis was confirmed by identifying a mutation in the COL11A2 gene that encodes the pre-pro-alpha2(XI) chain of type XI collagen that is involved in type II collagen fibrillogenesis.
  
  
  CONCLUSIONS
  Early-onset polyarticular OA may occur in adults without a known or obvious underlying skeletal dysplasia. This study provides an approach to the diagnosis of an underlying skeletal dysplasia in such individuals.
authors.affiliation: Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Tadej
authors.initials: T
authors.lastname: Avcin
authors.forename: Outi
authors.initials: O
authors.lastname: Makitie
authors.forename: Miki
authors.initials: M
authors.lastname: Susic
authors.forename: Stephen
authors.initials: S
authors.lastname: Miller
authors.forename: Carter
authors.initials: C
authors.lastname: Thorne
authors.forename: Jerry
authors.initials: J
authors.lastname: Tenenbaum
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Laxer
authors.forename: William G
authors.initials: WG
authors.lastname: Cole
mesh_terms: D000328:Adult; D000483:Alleles; D000595:Amino Acid Sequence; D001483:Base Sequence; D002648:Child; D024161:Collagen Type XI / Q000032:analysis / Q000235:genetics*; D004247:DNA / Q000235:genetics; D004838:Epiphyses / Q000000981:diagnostic imaging / Q000473:pathology; D005091:Exons / Q000235:genetics; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation / Q000235:genetics*; D010003:Osteoarthritis / Q000175:diagnosis* / Q000209:etiology*; D010009:Osteochondrodysplasias / Q000150:complications* / Q000235:genetics*; D010375:Pedigree; D011859:Radiography
chemical_list: C499319:COL11A2 protein, human; D024161:Collagen Type XI; D004247:DNA