Osteoarthritis (OA) affects various joints in the body but more often affects joints that carry the weight of the body, such as the knee joint and hip joint.¹  Knee OA is a major cause of chronic pain, functional disability, and poor quality of life in older people. Common clinical symptoms include knee pain that worsens with activity as well as early onset of movement after prolonged sitting or rest, as well as knee stiffness and swelling.²

Quality of life (QoL) is an important indicator in assessing the impact of OA. Factors such as pain, mobility limitations, and psychosocial disturbances due to OA can affect patients' daily activities, independence, and mental health. In addition, comorbidities such as obesity, diabetes, and hypertension can also worsen the condition of OA patients, which then affects the QoL of OA patients. Pain is a major cause of functional disability and negatively impacts various aspects of QoL, including activity, mood, and sleep quality.³

Elderly, obesity, and comorbid diseases can influence the QoL in knee OA patients. This affects the daily activities, such as muscle weakness, joint instability, morning stiffness, crepitus, and functional limitations, especially pain complaints. These conditions have been associated with morbidity and mortality and could affect the QoL. In addition, comorbid diseases such as diabetes mellitus, hypertension, cardiovascular disease, obesity, and hyperuricemia may affect the QoL of patients with knee OA.⁴

The 2016 Community Oriented Program for Control of Rheumatic Diseases (COPCORD) study in Colombia which comparing the QoL in patients with comorbidities and healthy people using the EQ-5D-3L method found that 4020 respondents with OA (55.4%) had a low QoL.⁵ This study aims to investigate the effects of age, body weight, and comorbidities with quality of life (QoL) of knee osteoarthritis patients

Type of Study

This study was an observational and analytical study involving 51 subjects of knee osteoarthritis patients aged over 50 years patients conducted in Makassar City, Indonesia in March 2024. Subjects were selected using a non- probabilistic method that met the inclusion criteria of the study.

Study population

The inclusion criteria in this study were subjects older than 50 years who had osteoarthritis of the knee unilateral or bilateral and were willing to become participants in the study. Exclusion criteria were subjects who previously suffered from systemic diseases such as rheumatoid disease, subjects with a history of knee trauma and subjects who were not willing to follow the research procedures.

Procedure

Baseline demographic data collected on the study subjects included gender, age, height and weight converted to body mass index (BMI), diseases experienced by patients and WOMAC score. Comorbidities such as Hypertension, Hyperuricemia, Type 2 DM, Dyslipidemia, Heart disease were identified based on the patient's history.

The data collection process in this study was by conducting home visits to the research subjects. Subjects who were willing to become participants previously filled out an informed consent form. Interviews were conducted directly at that time by guided by a facilitator to complete the questionnaire.

The research was conducted based on the ethical approval granted by the Health Research Ethics Committee (KEPK) of the Faculty of Medicine, Hasanuddin University, with the number: 111/UN4.6.4.5.31/PP36/2025.

Statistical Analysis

Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Subject characteristics were presented as means and standard deviations (SD). Frequencies and percentages were used for descriptive statistics. Results are presented in a narrative format, supplemented by tables to enhance clarity and understanding of the findings.

The study involved 51 subjects over the age of 50 with knee OA. Females were found more frequently than males (35.3% vs 64.7) with a mean age of 64.0 + 4.8 years. The average body weight was 68.9 + 17.2 kg where BB was found more than normal weight (78.4% vs 21.6%). WOMAC score was only found to be severe and very severe, where severe was found in 16 subjects (31.4%) and very severe in 35 subjects (68.6%). (Table.1)

Table 1. Characteristics of the Study

Association between age and QoL as measured by the WOMAC score of knee OA patients found that subjects with age> 60 years significantly (p<0.05) had a higher WOMAC score with a relative risk (RR) value found that subjects> 60 years had a risk of impaired QoL 5 -fold compared to subjects < 60 years. (Table 2).

Table 2. Association between Age and Quality of Life in Knee Osteoarthritis Patients

Association between body mass index and QoL measured by WOMAC score of knee OA patients found that patients with overweight significantly (p<0.05) had a higher WOMAC score with a relative risk (RR) value found that knee OA patients with overweight have a risk of QoL disorders 4.6 -fold compared to normal weight. (Table 3)

Table 3. Association between body mass index and quality of life in knee osteoarthritis patients

Association between comorbidities with QoL measured by WOMAC score of knee OA patients found that patients with comorbidities >2 significantly (p<0.05) had a higher WOMAC score with a relative risk (RR) value found that knee OA patients suffering from comorbidities >2 have a risk of QoL impairment 8 times compared to knee OA patients with comorbidities <2. (table 4).

Table 4. Association between Comorbidities and quality of life in knee osteoarthritis patients

Osteoarthritis is a common degenerative joint disease, characterized by progressive destruction of articular cartilage. Age is one of the major risk factors in the development of OA. Along with age, the prevalence of OA increases significantly. A cross-sectional study found that there are consistent structural changes with advancing age.⁶

In this study, we found that age is one of the factors that affect the QoL of knee OA patients (table 2). These results are consistent with a study by Araujo et al about quality of life and functional independence in knee OA patients aged more than 60 years, which concluded that there was a strong correlation between QoL and functional independence.⁷.

One of the major modifiable risk factors in the development of OA is overweight or obesity. Studies show that individuals with obesity have a 7.20 -fold higher risk of developing knee OA compared to those with normal weight.⁸. A meta-analysis involving various cohort and case-control studies showed a significant association between high body mass index (BMI) and increased risk of knee OA.⁹

The mechanism behind the link between obesity and OA involves an increased mechanical load on body-supporting joints, such as the knees and hips. Any weight gain puts additional stress on the joints, which can accelerate cartilage breakdown. In addition, adipose tissue produces pro-inflammatory cytokines that may contribute to the inflammatory process in the joint that worsens the OA condition.¹⁰

Overweight significantly impacts QoL in OA patients. Study shows that obese individuals with OA experience increased pain, decreased physical function, and reduced QoL compared to those with a normal body mass index (BMI).¹¹.

Common comorbid conditions in OA include cardiovascular disease, diabetes, hypertension and depression. The presence of these comorbidities can exacerbate OA symptoms, leading to increased pain and decreased physical function. Research shows that individuals with OA and additional comorbidities experience reduced QoL. A systematic review found that the presence of other chronic conditions in OA patients contributes to worsening pain and decreased functional activity .¹²

Comprehensive OA treatment should integrate weight management, physical therapy, pharmacological interventions, and mental health support to improve desired outcomes. Multidisciplinary management strategies that target comorbid conditions can significantly improve QoL by reducing pain, improving mobility, and supporting mental health. Future research should focus on individualized care plans that take into account the comorbidity profile to optimize OA management. Managing comorbidities in OA patients is crucial in preventing further disability and ensuring better long-term health outcomes.

In this study it can be concluded that Advanced age, overweight, and comorbidities are significantly associated with reduced QoL in knee OA patients. Multifactorial interventions are needed to improve QoL in this population.

Ethic approval

This study has been approved by the Research Ethics Committee of the Faculty of Medicine, Hasanuddin University through the publication of an ethical approval letter number 111/UN4.6.4.5.31/PP36/2025. The study adhered to the ethical principles, ensuring the protection of participants' rights and confidentiality.

Conflict of Interest: The authors declare no conflict of interest.

Authors Contribution: SE, FS, and TH drafted the manuscript. FS, AMA and SB designed and concepted the study. SE and AAZ collected and analyzed and interpreted the data. TH, AMA, and SB revised manuscript critically for important intellectual content. All authors participated in the final draft preparation, manuscript revision, and critical evaluation of the intellectual contents. All authors have read and approved the content of the manuscript and confirmed the accuracy or integrity of any part of the work

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