Summary: Osteoarthritis (OA) is the most common joint disorder representing a socioeconomic burden. Low-grade synovitis is a crucial factor in the pathogenesis of OA, producing proinflammatory cytokines and an imbalance between catabolism and anabolism of the articular cartilage. In recent years ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) evidence based recommendations for knee OA have been published to help guide clinical decision making. The recommended approach is to initiate background pharmacotherapy with chronic SYSADOA (Symptomatic Slow Acting Drugs in Osteoarthritis). Avocado soybean unsaponifiable (ASU) is one of the SYSADOAs with interesting anti-inflammatory and chondroprotective properties. ESCEO recommends the use of pharmaceutical-grade prescription SYSADOAs instead of diet supplements.