Osteoarthritis. A primary care approach for physicians in 2000 and beyond.

Osteoarthritis is one of the most common disorders presented to the primary care physician in the over 50 years age group in the Kingdom of Saudi Arabia. The diagnosis is made by history, typical x-ray findings and non-contributory laboratory investigations. The understanding of the pathogenesis of the condition is undergoing change. The development of osteoarthritis is dependent on age, sex, genetic predisposition, and previous trauma to the joint and abnormal mechanical forces caused primarily by obesity. Biochemically, there is an imbalance in the enzymes of cartilage degradation and cartilage regeneration. Management in 2000 focuses on patient education, appropriate exercise, relief of pain through judicious combination of capsaicin cream, acetaminophen in appropriate dose, and nonsteroidal anti-inflammatory drug therapy. The latter is undergoing revolutionary change with the introduction of the Coxiella-2 specific inhibitors, Rofecoxib and Celecoxib in the autumn of 2000 to the Kingdom. With these agents the primary care physician has an effective analgesic therapy, once a day dosing and a dramatic reduction in nonsteroidal anti-inflammatory drug gastropathy across all groups of patients. Finally, when the conservative management by the primary care physician is of benefit no longer, judicious referral to an experienced Orthopedic Surgeon for the modern surgical approaches should be given.