EXPLORING MULTIMORBIDITY PATTERNS IN PATIENTS WITH OSTEOARTHRITIS USING MACHINE LEARNING

Authors

  • Sari Dewi Nirmala Fakultas Farmasi, Universitas Ahmad Dahlan, Yogyakarta https://orcid.org/0009-0005-5347-8256
  • Darmawan Endang Fakultas Farmasi, Universitas Ahmad Dahlan, Yogyakarta
  • Surono Sugiyarto Fakultas Sains dan Teknologi Terapan (FAST), Universitas Ahmad Dahlan, Yogyakarta

DOI:

https://doi.org/10.36423/pharmacoscript.v9i1.2755

Keywords:

Osteoarthritis, multimorbidity, machine learning, FP-Growht, Therapy, hospitalization

Abstract

Osteoarthritis (OA) is a degenerative joint disease often accompanied by multimorbidity, particularly cardiometabolic diseases. OA is also associated with comorbidities, thus requiring an analytical approach capable of identifying patterns of relationships between diseases and rational therapies. This study aims to explore patterns of multimorbidity and treatment patterns in hospitalized patients with osteoarthritis using a machine learning (ML) approach. This study employed a retrospective design using medical records of hospitalized OA patients from January 2020 to January 2025 at Sultan Agung Islamic Hospital in Semarang. Analysis was performed using the Frequent Pattern Growth (FP-Growth) algorithm with support, confidence, and lift parameters. The minimum support value was set at 1% to identify a wider variety of patterns. A total of 25 patients were analyzed, with the majority being female (14 patients; 56%) and aged ≥59 years (14 patients;96%), with comorbidities predominantly obesity and hypertension. Association Rule Mining (ARM) results showed cardiometabolic multimorbidity patterns, with the strongest association in the combination OA+HTàDM (lift 1.93). Therapy pattern analysis indicated that disease combinations were associated with the use of therapies such as NSAIDs for OA and metformin for diabetes, as well as the addition of adjuvant therapies. Multimorbidity patterns in hospitalized OA patients are dominated by the cardiometabolic group, with complex therapeutic regimens. ML approaches are effective in identifying patterns of disease and therapy relationships, therapy supporting more rational clinical decision-making.

References

Adani, A. F., Hadipoetro, F., & Triturawati, E. (2021). Gambaran Faktor Risiko Pasien Osteoartritis Genu di Pelayanan Rehabilitasi Medik RSIJ Pondok Kopi Januari Desember 2019. Seminar Nasional Penelitian LPPM UMJ.

Alshahrani, A. S., Aljaffar, A. B., Albin Ahmed, B. J., Altabash, M. W., Dajani, Z. A., Alamer, A. H., Alzawad, A. J., Alanii, F., & Alzahrani, M. M. (2025). Correlation between Kellgren-Lawrence classification of osteoarthritis and Knee Injury and Osteoarthritis Outcome Score. World Journal of Orthopedics, 16(11). https://doi.org/10.5312/wjo.v16.i11.111953

Anthonimuthu, D. J., Hejlesen, O., Zwisler, A.-D. O., & Witt, F. (2025). Application of Machine Learning in Multimorbidity Research: Protocol for a Scoping Review. JMIR RESEARCH PROTOCOLS.

Astiani, R., Anggraeni, R., Luthfiana, F., Sari, D. P., Laila, D., Khan, K., & Ananta, I. W. (2025). Terapi Obat Pada Pasien Osteoarthritis Hip Dextra Grade 4 Dengan Komorbid Hipertensi Dan Diabetes Melitus Tipe 2. Social Clinical Pharmacy Indonesia Journal.

Butarbutar, J. Cp., Basuki, P., Sungono, V., Riantho, A., & Fidiasrianto, K. (2024). Burden of osteoarthritis in Indonesia: A Global Burden of Disease (GBD) study 2019. Narra J, 4(2), e884. https://doi.org/10.52225/narra.v4i2.884

Chen, S., Chen, M., Chen, C., Xie, C., Yu, Y., Shao, Z., & Xiao, G. (2025). Epidemiological Trends And Characteristics Of Osteoarthritis in China during 1990–2021. Journal of Orthopaedic Translation, 51, 218–226. https://doi.org/10.1016/j.jot.2025.02.006

Ching, A., Prior, Y., Parker, J., & Hammond, A. (2023). Biopsychosocial, work-related, and environmental factors affecting work participation in people with Osteoarthritis: A systematic review. BMC Musculoskeletal Disorders, 24(1), 485. https://doi.org/10.1186/s12891-023-06612-6

Coaccioli, S., Sarzi-Puttini, P., Zis, P., Rinonapoli, G., & Varrassi, G. (2022). Osteoarthritis: New Insight on Its Pathophysiology. Journal of Clinical Medicine, 11(20), 6013. https://doi.org/10.3390/jcm11206013

Courties, A., Kouki, I., Soliman, N., Mathieu, S., & Sellam, J. (2024). Osteoarthritis year in review 2024: Epidemiology and therapy. Osteoarthritis and Cartilage, 32(11), 1397–1404. https://doi.org/10.1016/j.joca.2024.07.014

Dai, D., Sharma, A., Alvarez, P. J., & Woods, S. D. (2022). Multiple Comorbid Conditions And Healthcare Resource Utilization Among Adult Patients With Hyperkalemia: A Retrospective Observational Cohort Study Using Association Rule Mining. Journal of Multimorbidity and Comorbidity, 12, 26335565221098832. https://doi.org/10.1177/26335565221098832

De Luca, V., Virgolesi, M., Vetrani, C., Aprano, S., Cantelli, F., Di Martino, A., Mercurio, L., Iaccarino, G., Isgrò, F., Arpaia, P., Colao, A., & Illario, M. (2025). Digital interventions for weight control to prevent obesity in adolescents: A systematic review. Frontiers in Public Health, 13, 1584595. https://doi.org/10.3389/fpubh.2025.1584595

Dell’Isola, A., Recenti, F., Englund, M., & Kiadaliri, A. (2024). Twenty-year trajectories of morbidity in individuals with and without osteoarthritis. RMD Open, 10(2), e004164. https://doi.org/10.1136/rmdopen-2024-004164

Delord, M., Sun, X., Learoyd, A., Curcin, V., Wolfe, C., Ashworth, M., & Douiri, A. (2024). Patient-oriented unsupervised learning to uncover the patterns of multimorbidity associated with stroke using primary care electronic health records. BMC Primary Care, 25(1), 419. https://doi.org/10.1186/s12875-024-02636-6

Dhaifullah, M. R., Meregawa, P. F., Aryana, I. G. N. W., & Subawa, I. W. (2023). Hubungan Usia, Jenis Kelamin, Dan Pekerjaan Terhadap Derajat Keparahan Penderita Osteoartritis Lutut Berdasarkan Kellgren-Lawrence Di Rsup Sanglah Denpasar. E-Jurnal Medika Udayana, 12(1), 107. https://doi.org/10.24843/MU.2023.V12.i01.P18

Du, S., Liu, J., & Fu, Z. (2021). The Impact of Village Rules and Formal Environmental Regulations on Farmers’ Cleaner Production Behavior: New Evidence from China. International Journal of Environmental Research and Public Health, 18(14), 7311. https://doi.org/10.3390/ijerph18147311

Evers, S. (2021). Non-Invasive Neurostimulation Methods for Acute and Preventive Migraine Treatment—A Narrative Review. Journal of Clinical Medicine, 10(15), 3302. https://doi.org/10.3390/jcm10153302

Faruetti, M. L., De la Torre, A. M., Burkard, T., Obozinski, G., & M.Burden, A. (2022, December 12). Identification of polypharmacy patterns in new-users of metformin using the Apriori algorithm: A novel framework for investigating concomitant drug utilization through association rule mining. International Conference for Pharmacoepidemiology.

Fujita, R., Ota, S., Yamamoto, Y., Kataoka, A., Warashina, H., Inoue, T., Ozeki, S., & Sugiura, H. (2023). Effect of diabetes mellitus on physical activity in patients with knee osteoarthritis: A cross-sectional study. Journal of Orthopaedic Surgery, 31(2), 10225536231197726. https://doi.org/10.1177/10225536231197726

Halabitska, I., Oksenych, V., & Kamyshnyi, O. (2024). Exploring the Efficacy of Alpha-Lipoic Acid in Comorbid Osteoarthritis and Type 2 Diabetes Mellitus. Nutrients, 16(19), 3349. https://doi.org/10.3390/nu16193349

Hidayah, L., Darmawan, E., & Yuliani, S. (2022). The increased risk of random blood glucose, body mass index and abdominal circumference in the schizophrenic patients using clozapine and quetiapine. Pharmacology, medical reports, orthopedic, and illness details (comorbid), 1(1), 83–92. https://doi.org/10.55047/comorbid.v1i1.67

Jannah, N. I., & Rahman, F. (2023). Beda Profil Status Well-Being pada Kondisi Osteoarthritis, Diabetes Mellitus Tipe II dan Hipertensi Berdasarkan Tingkat Pendidikan. Jurnal Kesehatan, 280–290. https://doi.org/10.23917/jk.v16i3.2544

King, L. K., March, L., & Anandacoomarasamy, A. (2020). Obesity & osteoarthritis. Indian J Med Res, 138.

Mustaqim, M. R. R., Lufiana, F., & Rangkuti, D. M. (2025). Hubungan Antara Tingkat Aktivitas Fisik Dengan Derajat Keparahan Osteoartritis. Jambura Health and Sport Journal, 7(2).

NICE. (2016). Multimorbidity: Clinical assessment and management. National Institute for Health and Care Excellence.

Nugraha, R. W., Kurniati, M., Detty, A. U., & Marlina, D. (2023). Hubungan antara usia, pekerjaan dan jenis kelamin dengan kejadian osteoarthritis di RSUD dr. H. Abdul moeloek provinsi lampung. Jurnal Ilmu Kedokteran dan Kesehatan, 10(10), 3073–3082. https://doi.org/10.33024/jikk.v10i10.12728

Otgonbaatar, U., Zhang, X., Zhang, M., & Zhang, C. (2025). Prevalence of multimorbidity among urban–rural older adults in Mongolia: A cross-sectional study. BMC Public Health, 25(1), 1993. https://doi.org/10.1186/s12889-025-22804-2

Seakamela, K. P., Mashaba, R. G., Ntimana, C. B., Kabudula, C. W., & Sodi, T. (2025). Multimorbidity Management: A Scoping Review of Interventions and Health Outcomes. International Journal of Environmental Research and Public Health, 22(5), 770. https://doi.org/10.3390/ijerph22050770

Shi, X., & Schlenk, E. A. (2022). Association of Hypertension with Knee Pain Severity Among People with Knee Osteoarthritis. Pain Management Nursing, 23(2), 135–141. https://doi.org/10.1016/j.pmn.2021.08.002

Steinmetz, J. D., Culbreth, G. T., Haile, L. M., Rafferty, Q., Lo, J., Fukutaki, K. G., Cruz, J. A., Smith, A. E., Vollset, S. E., Brooks, P. M., Cross, M., Woolf, A. D., Hagins, H., Abbasi-Kangevari, M., Abedi, A., Ackerman, I. N., Amu, H., Antony, B., Arabloo, J., … Kopec, J. A. (2023). Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet Rheumatology, 5(9), e508–e522. https://doi.org/10.1016/S2665-9913(23)00163-7

Tsang, J. Y., Sperrin, M., Blakeman, T., Payne, R. A., & Ashcroft, D. (2024). Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: A scoping review. BMJ Open, 14(5), e081698. https://doi.org/10.1136/bmjopen-2023-081698

Unverzagt, S., Bergmann, A., Denny, K., Frese, T., Hirpa, S., & Weyer, J. (2024). Physically Demanding Occupations Among Females And Sex-Related Differences To Develop Osteoarthritis Of The Hip: A Systematic Review And Meta-Analysis. Journal of Occupational Medicine and Toxicology, 19(1), 14. https://doi.org/10.1186/s12995-024-00415-8

Wei, G., Lu, K., Umar, M., Zhu, Z., Lu, W. W., Speakman, J. R., Chen, Y., Tong, L., & Chen, D. (2023). Risk of metabolic abnormalities in osteoarthritis: A new perspective to understand its pathological mechanisms. Bone Research, 11(1), 63. https://doi.org/10.1038/s41413-023-00301-9

Xie, H., Jia, Y., & Liu, S. (2024). Integration of artificial intelligence in clinical laboratory medicine: Advancements and challenges. Interdisciplinary Medicine, 2(3), e20230056. https://doi.org/10.1002/INMD.20230056

Xu, G., Song, Q., Jia, M., Yu, Y., Su, S., & Mao, J. (2025). Network Dynamics Of Metabolic Disease Continuum In Older Adults: A 7-Year Longitudinal Cohort Study In China. BMC Geriatrics, 26(1), 94. https://doi.org/10.1186/s12877-025-06882-w

Yang, Z.-J., Liu, Y., Liu, Y.-L., Qi, B., Yuan, X., Shi, W.-X., & Miao, L. (2024). Osteoarthritis and hypertension: Observational and Mendelian randomization analyses. Arthritis Research & Therapy, 26(1), 88.

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Published

2026-04-16