These case histories illustrate how medical, psychosocial, cultural and economic factors affect the elderly with chronic arthritis. Physicians need to be aware of their patient's attitudes, concerns, support systems and goals resulting from a lifetime of experience, to provide the most appropriate and effective care. 'Images of future are usually only caricatures of the present' (Starr, 1982), but based on current demography, one can predict trends for the future. It is likely that the elderly of the future will be better off financially, better educated, healthier, more politically connected and strident, but their social support systems will be less effective. The last stems from trends such as declining birth rate, an increasingly mobile society, diminished importance of the nuclear family, and the diminishing attractiveness of professions involved with providing maintenance care. This suggests that the physician and nurse, being the primary gatekeepers for the care of and services for the elderly, must be even more attentive to the non-biological determinants of arthritis disability.