Abstract: The present invention relates to methods and pharmaceutical compositions for the treatment of osteoarthritis. The inventors showed that accumulated metabolic risk factors, hypertension, obesity, dyslipidemia, insulin resistance (known as metabolic syndrome), lead to severe osteoarthritis articular phenotype. They showed in rats that preventive and chronic mineralocorticoid receptor antagonist eplerenone treatment can improve the metabolic syndrome related osteoarthritis. In particular, the present invention relates to an antagonist of mineralocorticoid receptor for use in a method for the treatment of osteoarthritis in a subject in need thereof.