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Osteoarthritis (OA) is a chronic progressive disorder that typically requires multiple treatment modalities over the course of disease. Osteoarthritis occurs frequently in older age, and the incidence of OA is rising owing to an aging population and association with obesity [1]. Older patients often have comorbidities and are at an increased risk of cardiovascular, gastrointestinal (GI), and renal adverse events (AEs), which impact on the appropriate choice of anti-OA medication. The contemporary model of evidence-based medicine is predicated on the principle that clinical decisions and recommendations are data driven. Recommendations are based on the balance of relative benefits and harms of the treatment and patients’ values and preferences. Often, the choice of medication is reduced to a trade-off between desirable and undesirable outcomes. While multiple guidelines exist for the treatment of OA [2–6], they contain varying levels of detail concerning the safety and side effects of OA therapies. Consequently, a summary of the current evidence base is timely. A working party was convened by the the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (1 December, 2017) to discuss current knowledge on the safety of anti-OA medications. New systematic reviews and meta-analyses were presented by several members of the working party, and their research findings are reported in this supplement. Paracetamol has long been widely used for analgesia in OA; its widespread use is driven largely by an assumption of relative safety and despite evidence for its poor efficacy in OA. In recent years, evidence is mounting for cardiovascular, GI, renal, and hepatic AEs occurring with long-term paracetamol exposure. In this issue, Conaghan et al. provide a critical review of the literature on paracetamol safety, recommending a cautious approach to the use of paracetamol for chronic pain management in OA [7]. Non-steroidal anti-inflammatory drugs (NSAIDs) play a central role in the management of pain in OA. While moderately effective on OA pain, NSAIDs are associated with wide-ranging toxicities affecting the GI, cardiovascular, and renal systems. In a narrative literature review, Cooper et al. [8] provide a synopsis of safety data on non-selective NSAIDs published since the Cochrane review of 2011 [9]. Gastrointestinal toxicity is found with all NSAIDs, which

Importance of Safety in the Management of Osteoarthritis and the Need for Updated Meta-Analyses and Recommendations for Reporting of Harms