Comments on: Sex - and obesity-related variations in pain and functional mobility among knee osteoarthritis patients: A cross-sectional analysis

Dear Editor,

We read with great interest the article by El-gohary which examined the influence of sex and obesity on pain and functional mobility in individuals with knee osteoarthritis (OA).^[1] The author should be commended for addressing clinically important factors that meaningfully influence disease burden and functional outcomes in OA. His findings contribute to the growing literature emphasizing personalized management in musculoskeletal rehabilitation.

The authors’ observation that obese individuals and females experience greater pain, reduced mobility, and longer disease chronicity aligns with previous epidemiological data demonstrating that obesity is both a mechanical and metabolic driver of OA progression. Excess body weight induces increased joint loading and adipokine-mediated low-grade systemic inflammation, both of which exacerbate cartilage degeneration and functional decline.^[2,3] Given the global rise in obesity and aging populations, these findings underscore the need for early preventive strategies, including structured weight-management interventions and targeted strengthening programs.

However, we believe that the discussion could be further enriched by addressing the interaction between obesity, sarcopenia, and functional deterioration. Recent evidence suggests that sarcopenic obesity confers a substantially higher risk of knee OA and disability than obesity alone, especially among females.^[4] Incorporating muscle-strength assessments or functional strength indices would have provided additional insight into the mobility impairments observed.

Furthermore, while the study effectively used timed up and Go (TUG) and 50-foot timed walk tests as clinical outcome measures, a justification of the minimal clinically important differences for these tests in knee OA populations would help contextualize the clinical relevance of the reported values. Previous studies indicate that even small changes in walk tests or the TUG may reflect meaningful gains in independence and reduced fall risk among older adults.^[5,6]

Finally, the author highlighted significant sex-related differences. Beyond pain perception, hormonal influences, proprioceptive variations, and disparities in muscular strength may contribute to worse functional outcomes in females.^[7] Addressing these factors in future research may guide the development of sex-specific rehabilitation protocols.

Overall, El-gohary’s study provides valuable clinical evidence supporting the need for individualized OA management. Future studies using larger samples, longitudinal designs, and multivariate modeling may further clarify the interplay of modifiable and non-modifiable risk factors influencing functional decline in knee OA. Incorporating specific modifiable factors such as body weight, physical activity level, and lower-limb muscle strength, alongside non-modifiable factors including age, sex, and genetic predisposition, would provide a more comprehensive framework for identifying contributors to functional deterioration. Highlighting these variables in future research will help in developing more targeted, evidence-based rehabilitation strategies for individuals with knee OA.