A genome-wide association study has revealed sequence variants that confer an increased risk of severe osteoarthritis (OA) of the hand. A group of common variants at 15q22 (represented by rs12907038[G]; frequency 50.7%, odds ratio [OR] 1.51, P = 3.99 × 10−10), located within the ALDH1A2 gene, were associated with hand OA in the discovery set of Icelandic individuals (n = 2,230); the association was replicated consistently in five additional European sample sets. The investigators also describe a rare variant at the 1p31 locus (frequency 0.02%, OR = 50.6, P = 9.8 × 10−10), which in one Icelandic family with a large number of cases segregated with severe hand OA and generalized OA. The rare variant was also found in other European populations, with 6 of the 15 carriers identified known to have hand or knee OA.