## 4 Discussion
In this regard, it is essential that different levels of physical activity are considered in future research since some low-impact activities, such as walking or swimming, may be recommended for people suffering from OA because they reduce the load on the affected joints [12]. Also, as noted in the introduction, medication use in individuals with OA is associated with lower levels of physical activity as they have higher levels of pain, which makes movement difficult [28; 29; 30]. Although our results did not find a significant association between medication use and physical activity levels, a relationship was observed between medication use and pain level. This was expected, given that medication often relieves pain in people suffering from chronic pain [50]. Furthermore, the level of pain was higher in those with bilateral OA, which was also expected since scientific evidence has shown that people with bilateral OA have a lower quality of health compared to those with unilateral OA and lower levels of pain [51]. However, it is interesting to note that in our results, the involvement of multiple body parts, as in the case of bilaterality, did not show the same relationship with pain when considering the coexistence of OA in both joints, hip, and knee. Individuals with both hip and knee OA often experience heightened fatigue, which can significantly impair their physical functionality and restrict daily activities [52; 53]. The combined effects of fatigue and pain in those with concurrent hip and knee OA likely exacerbate the decline in physical function. Although our study did not find a significant link between the coexistence of hip and knee OA and pain, previous research highlights that knee OA pain is generally persistent and associated with overall movement, while hip OA pain is typically more intense, localized, and emotionally draining [54; 55]. Despite these differences in pain characteristics, the overall pain levels between the two conditions might not differ significantly. Research has shown that pain in individuals with knee OA [56] and hip OA [57] is related to the severity of the disease. However, [PERSON] et al. [57] observed that pain levels were correlated with severity mainly in individuals with advanced stages, rather than those with milder forms of the disease. The coexistence of both types of OA could place an additional burden on affected joints, particularly in individuals with excess weight [58; 59], increasing the likelihood of reaching greater severity levels and further compromising physical functionality. A deeper understanding of the specific pain profiles in individuals with both hip and knee OA is necessary to better grasp how these conditions interact and impact disease severity and physical function, a factor not examined in this study. This could explain why the presence of both conditions is associated with greater severity and reduced functionality in those with OA in both affected areas. Future research should, therefore, investigate limb alterations in more detail, particularly considering the coexistence of multiple pathologies and bilateral OA as bilateral involvement has also been linked to functional impairments. We also examined whether the age of individuals with osteoarthritis (OA) was related to health antecedents, levels of physical activity, and functionality problems. Interestingly, our results indicated that these variables were not affected by age. As mentioned previously, OA can also affect younger adults due to various factors such as joint injuries, genetic predispositions, and lifestyle choices [11]. Moreover, it has been shown that COVID-19 may disrupt endothelial and adipose tissue, potentially accelerating aging processes similar to early osteoarthritis, with joint and muscle pain reflecting characteristics of age-related musculoskeletal decline [19]. The fact that this study was conducted after the COVID-19 pandemic may explain why individuals who contracted the virus could present OA symptoms at a younger age.