Many current treatments for OA are thought to target the synovium e.g. NSAIDs and this may be why they are effective. Changes in the subchondral bone are also common on MRI and are also associated with pain. At present most data assume that OA pain is nociceptive in origin and there is limited evidence for a neuropathic mechanism. All available treatments for OA are directed at symptom control as there are not yet any widely accepted drugs that can affect the structural progression of OA. Current guidelines recommend a combination of non-pharmacological and pharmacological management. Treatment needs to be adjusted according to individual symptoms, past medical history, comorbidities and lifestyle. NSAIDs, for example, may be inappropriate in a patient with renal impairment, gastrointestinal diseases or a history of ischaemic heart disease.The initial approach centres on self-help and patient-driven treatments and should be started in primary care. This includes: education, advice and access to information. Both verbal information and patient information leaflets should be offered; local strengthening exercises and aerobic fitness training; weight loss in patients who are overweight or obese. [With external links to the evidence base]