Osteoarthritis (OA) is a disease of diarthrodial joints that leads to joint degeneration, inflammation, and pain. It is the most prevalent disabling disease globally. Despite efforts to develop a disease modifying treatment, the only accepted and available clinical approaches involve palliation. While many factors contribute to the development of OA, the gut microbiome has recently emerged as an important pathogenic factor in OA initiation and progression, particularly in the context of obesity. Investigators in this field are currently working to uncover defined molecular and inflammatory links between the gut and joints. This work sets the stage for the development of new strategic approaches to OA disease modification that could represent the first alternatives to palliation. This presentation will provide an up-to-date review of the literature regarding the link between the gut microbiome and OA.