The management of osteoarthritis in the third millennium

Osteoarthritis (OA) is already the most common disorder of joints, and is likely to go on increasing in prevalence. Primary prevention, although theoretically possible, is unlikely to occur because it would need major behavioural changes within society as a whole. Similarly, disease control through drugs seems unlikely to be achieved for a disorder that is an age-associated, mechanically driven "disorder of evolution". Current treatment is not very effective (with the exception of joint replacement), is dominated by drug therapy, and by the interests of those in the secondary care sector. The information revolution, combined with increasing understanding of the nature of OA, is likely to lead to major changes in management strategies in the future. There may be little of no place for the rheumatologist within future management of OA.