Objective: The aims of this study were to modulate inflammation in synovial explants with the compounds: dexamethasone, rapamycin, bone morphogenetic protein 7 (BMP-7) and pravastatin, and to investigate the modulatory capacity of the compounds on specific macrophage phenotypes. Design: Synovial explants from osteoarthritis (OA) patients were treated with 10(-6) M dexamethasone, 100 ng/mL rapamycin, 500 ng/mL BMP-7 or 50 mu M pravastatin. Half of the explants were pre-stimulated with IFN gamma + TNF alpha to simulate acute inflammation. Inflammatory state of the synovium was assessed with gene expression analysis. Primary human monocytes were isolated and stimulated towards macrophage phenotypes M(IFN gamma + TNF alpha), M(IL-4) and M(IL-10) with the respective cytokines, followed by treatment with the compounds. Results: Dexamethasone had an anti-inflammatory effect on IFN gamma + TNF alpha stimulated and osteoarthritic synovium, likely due to suppression of pro-inflammatory M(IFN gamma + TNF alpha) macrophages while enhancing anti-inflammatory M(IL4) and M(IL10) macrophages. Rapamycin and BMP-7 further enhanced inflammation in stimulated synovium, but rapamycin did not have a clear effect on non-stimulated synovium. Rapamycin suppressed M(IL-4) and M(IL-10) macrophages without affecting M(IFN gamma + TNF alpha). BMP-7 suppressed M(IFN gamma + TNF alpha) and enhanced M(IL-10) in the macrophage cultures. Pravastatin did not affect synovium, but enhanced M(IL-10). Conclusions: These data indicate that macrophage phenotype modulation can be used to guide joint inflammation and thereby contribute to the development of new therapies to delay the progression of OA. The varying effects of the compounds on synovium of different degrees of inflammation, indicate that the modulatory capacity of the compounds depends on OA stage and underlines the importance of identifying this stadium for adequate treatment. (C) 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.