Osteoarthritis (OA) is a commonly encountered clinical entity, often with debilitating consequences for the sufferer. Treatment for symptomatic end stage disease is often in the form of surgery. Previously thought of as a purely degenerative condition, it is now increasingly recognised that through a number of mechanical, metabolic and molecular pathways, there is also an inflammatory component in the surrounding periarticular tissues which may contribute to disease progression. As our understanding of OA at the cellular and genetic level deepens, so grow the opportunities for early therapeutic intervention to slow or even halt progression.