Osteoarthritis (OA) is characterized by deterioration of the joints and associated with considerable pain and disability. OA is a chronic disease that requires intervention with both non-pharmacological and pharmacological treatment modalities and, inevitably, disease progression may necessitate successive treatments throughout the course of the disease. There is increasing data on the shortfalls of current pharmacological treatment of OA, and safety concerns associated with analgesic therapy use in OA arising from increasing evidence of gastrointestinal, cardiovascular, hepatic and renal adverse events with paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Consequently, symptomatic slow-acting drugs for OA (SYSADOAs) may now be considered as a first-line treatment for knee OA, with a particular emphasis placed on the outstanding benefit: risk ratio of pharmaceutical-grade glucosamine and chondroitin sulfate formulations. In this short communication we review recent publications concerned with the safety of paracetamol, NSAIDs and SYSADOAs. Greater understanding of the benefits and limitations of current medications will lead to better disease management in OA. Furthermore, adherence to guideline recommendations across Europe and internationally, such as those from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), will promote evidence-based medicine and patient-centric care, ultimately leading to greater physician and patient satisfaction.

2 Department of Orthopaedic and Trauma Surgery Faculty of Medicine in Bratislava Comenius University University Hospital Bratislava Bratislava Slovakia

Clinic of Rheumatology MMA Medical Faculty University of Defence Military Medical Academy Belgrade Serbia

Clinical Pharmacology and Pharmacovigilance Operative Unit Department of Health Sciences MaterDomini Hospital Catanzaro University of Magna Graecia Catanzaro Catanzaro Italy

Department of Internal Medicine Clinic of Endocrinology Medical University Sofia University Hospital Alexandrovska Sofia Bulgaria

Department of Internal Medicine Rheumatology and Clinical Immunology Medical University of Silesia Katowice Poland

Department of Orthopedics General Hospital Jesenice Jesenice Slovenia

Department of Pediatric Rheumatology Immunology and Metabolic Bone Diseases Medical University of Bialystok Bialystok Poland

Department of Sports Medicine Faculty of Medicine University of Debrecen Debrecen Hungary

Division of Public Health Epidemiology and Health Economics University of Liège CHU Sart Tilman B23 4000 Liege Belgium WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging Liege Belgium

Division of Public Health Epidemiology and Health Economics University of Liège CHU Sart Tilman B23 4000 Liege Belgium WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging Liege Belgium Chair for Biomarkers of Chronic Diseases Biochemistry Department College of Science King Saud University Riyadh Kingdom of Saudi Arabia

Institute of Rheumatology University of Belgrade Medical School Resavska 69 Belgrade Serbia

Orthopedic and Trauma Department Medical Veteran's Memorial Hospital University of Lodz Lodz Poland

Osteocentrum Mediekos Ltd Orthopedics Ortopedie Hradiště Ltd Uherské Hradiště Czech Republic

Rheumatology Clinic Medical Faculty University Hospital St Iv Rilski Medical University Sofia Bulgaria

Ultramedica Vošnjakova 1 Ljubljana Slovenia

WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging Liege Belgium MRC Lifecourse Epidemiology Unit Southampton General Hospital University of Southampton Southampton UK National Institute for Health Research Musculoskeletal Biomedical Research Unit University of Oxford Oxford UK

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