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 Arab
ia. The diagnosis is made by history, typical x-ray findings and non-contri
butory laboratory investigations. The understanding of the pathogenesis of
the condition is undergoing change. The development of osteoarthritis is de
pendent on age, sex, genetic predisposition, and previous trauma to the joi
nt and abnormal mechanical forces caused primarily by obesity. Biochemicall
y, there is an imbalance in the enzymes of cartilage degradation and cartil
age regeneration. Management in 2000 focuses on patient education, appropri
ate exercise, relief of pain through judicious combination of capsaicin cre
am, acetaminophen in appropriate dose, and nonsteroidal anti-inflammatory d
rug therapy. The latter is undergoing revolutionary change with the introdu
ction of the Coxiella-2 specific inhibitors, Rofecoxib and Celecoxib in the
autumn of 2000 to the Kingdom. With these agents the primary care physicia
n has an effective analgesic therapy, once a day dosing and a dramatic redu
ction 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 Ort
hopedic Surgeon for the modern surgical approaches should be given.