Treatment for osteoarthritis has historically been limited to symptomatic therapies, which treat the symptoms but not the cause, and therefore not modifying the underlying progression of the disease. In recent years, successful treatments for osteoarthritis (that treat both the underlying pathology as well as the symptoms) have been identified. This has been made possible by abandoning a “one size fits all” approach to disease treatment, and instead using targeted approaches by treating patients according to disease phenotypes. Such advances have been made possible by the advent of magnetic resonance imaging technology, which enable visualisation of individual structures within the joint. Disease phenotypes include a bone-active subtype (particularly bone marrow lesions), which have been successfully treated using bone-active drugs typically used for osteoporosis. Other emerging subtypes include inflammation (effusion, synovitis), for which anti-inflammatory therapies are being trialled.