Vision of the future in arthritis care.

Demographic changes during the next 10-20 years will significantly affect the future of arthritis care. Not only will the prevalence of chronic diseases increase among an increasingly aging population, but so will their incidence. The management of chronic diseases will become the primary clinical challenge for many physicians, especially rheumatologists. Patients will present to their rheumatologists expecting an accurate diagnosis to be made at the onset of their symptoms. To do so, clinicians will have to establish the pathophysiologic bases of the different types of arthritis, most likely through the use of sophisticated imaging techniques, such as high-resolution ultrasound. Treatment approaches will become more targeted. Agents that specifically inhibit the cyclooxygenase-2 (COX-2) isozyme will likely be used for symptomatic relief in arthritis patients. Other therapies will be targeted toward cartilage regeneration. suppression of the inflammatory process, and inhibition of metalloproteinases.