Summary: Updated European and American recommendations for the treatment of knee osteoarthritis (OA) were published in 2019. These recommendations remain mostly convergent, underlining the principal role of NSAIDs. The biggest difference concerns the use of symptomatic slow-acting drugs in OA (SYSADOA), which received a negative recommendation in the U.S. guidelines. There are currently no criteria for the diagnosis of early OA, but it seems that this is a key period for the development of the entire disease. Due to their safety and mechanism of action (anti-inflammatory and chondroprotective effect), therapy with the unsaponifiable fractions of avocado and soybean oil (ASU) can bring a significant positive effect in early knee OA.