Early-Onset Osteoarthritis Due to Otospondylomegaepiphyseal Dysplasia in a Family with a Novel Splicing Mutation of the COL11A2 Gene

TADEJ AVCIN, OUTI MAKITIE, MIKI SUSIC, STEPHEN MILLER, CARTER THORNE, JERRY TENENBAUM, RONALD M. LAXER, and WILLIAM G. COLE

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-a2(XI) chain of type XI collagen that is involved in type II collagen fibrillogenesis.

Conclusion. 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. (J Rheumatol First Release Mar 15 2008)

Key Indexing Terms:

OSTEOARTHRITIS
SKELETAL DYSPLASIA
COLLAGEN
GENETICS
OTOSPONDYLOMEGAEPIPHYSEAL DYSPLASIA

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From the Divisions of Rheumatology and Orthopaedics and the Departments of Paediatrics and Diagnostic Imaging, The Hospital for Sick Children; the Departments of Paediatrics, Medicine, Diagnostic Imaging and Surgery, University of Toronto; and the Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada.

Dr. Cole was supported by a grant from the Canadian Institutes of Health Research.

T. Avcin, MD, Division of Rheumatology; O. Makitie, MD, Division of Orthopaedics; M. Susic, MSc, Division of Orthopaedics, The Hospital for Sick Children; S. Miller, MD, Division of Diagnostic Imaging, The Hospital for Sick Children, Department of Diagnostic Imaging, University of Toronto; C. Thorne, MD, Newmarket, ON; J. Tenenbaum, MD, Division of Rheumatology, Mount Sinai Hospital, Department of Medicine, University of Toronto; R. Laxer, MD, Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, Departments of Paediatrics and Medicine, University of Toronto; W.G. Cole, MBBS, PhD, Division of Orthopaedics, The Hospital for Sick Children, Department of Surgery, University of Toronto.

Address reprint requests to Dr. W. Cole, Division of Orthopaedics, Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1X8, Canada. E-mail: william.cole@sickkids.ca

Accepted for publication November 26, 2007.