There has been important recent progress in our understanding of the molecular pathology of osteoarthritis (OA) and how it might be treated. New technologies have been developed and others refined to identify patients for recruitment in clinical trials who exhibit measurable progression. Combined with the ability to determine more effectively short-term efficacy of treatment, significant obstacles are being removed that have negated or led to the failure of earlier trials. The future for disease-modifying osteoarthritis drug (DMOAD) development and more effective pain control is therefore much more encouraging. But it is extremely important that these new therapeutic and clinical trial opportunities receive timely recognition and support from regulatory authorities. The importance and clearly demonstrated value of the coordination of clinical research and private/public initiatives, such as the OA Initiative and the European APPROACH project, and involvement of informed patients in research and policy decision making cannot be over emphasised.