Clinical expert statement on osteoarthritis: diagnosis and therapeutic choices

Osteoarthritis (OA) is a chronic, progressive disease that affects bones and joint structures. Osteoarthritis is associated with joint pain, cartilage degradation, synovial inflammation, subchondral bone remodeling and osteophyte formation. It mainly impacts the knees, hips, hands, and lumbar spine. Despite its high prevalence, no current treatments can modify the course of OA, with most therapies focused on symptomatic relief. Non-pharmacological approaches such as weight management, exercise, and self-management programs are strongly recommended. Nonsteroidal anti-inflammatory drugs (NSAIDs), both topical and oral, are commonly used but pose risks with long-term use. In contrast, symptomatic slow-acting drugs for OA, such as glucosamine, chondroitin, and avocado-soybean unsaponifiables (ASU), offer a safer alternative, but their effects remain controversial. Newer therapies, including intra-articular glucocorticosteroids, hyaluronic acid, and centrally acting agents such as duloxetine, offer targeted relief. Emerging evidence suggests that ASU may help reduce pain and improve joint function, potentially lowering the need for NSAIDs, with minimal side effects.