I read with great interest Dr Jawad's letter and the authors' reply about the EULAR recommendations for the management of knee osteoarthritis (OA).1 ,2

As a member of the ESCISIT task force I feel free to discuss some of the issues raised by Dr Jawad and to give further arguments for the accuracy of the recommendations developed by the group of European experts.3

Although most points of criticism were answered by M Dougados and M Doherty it seems to me that treatment of knee OA with symptomatic slow acting drugs in osteoarthritis (SYSADOA) and cyclo-oxygenase-2 (COX-2) inhibitors needs to be discussed in a different way in the light of recent publications.

With respect to SYSADOA, the statement that these substances may modify structure has been strengthened by the publication of Reginsteret al, in which glucosamine sulphate (GS) treatment was proved to exert a significant decrease in joint space narrowing compared with placebo during a three year period, indicating the disease modifying effect of GS …