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Title: Tibialis posterior tenosynovitis in rheumatoid arthritis : targeting mechanics and inflammation
Author: Barn, Ruth
ISNI:       0000 0004 2718 1964
Awarding Body: Glasgow Caledonian University
Current Institution: Glasgow Caledonian University
Date of Award: 2012
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Introduction: The tibialis posterior (TP) tendon is vulnerable to inflammatory damage in rheumatoid arthritis (RA). TP tendon disease is frequently associated with pes pIano valgus (PPV) deformity; both inflammatory and mechanical factors are thought to contribute. Minimal evidence exists in terms of the contribution of the TP muscle, determined by electromyography (EMG), to the deformity in RA. To date this has not been combined with current multi-segment foot (MSFoot) models or diagnostic imaging. Moreover, the response of these features to intervention is currently unknown. The aim of this study was to undertake a detailed description of TP tenosynovitis and PPV in RA and to determine the effect of targeting mechanics and inflammation. Methods: Patients with RA and PPV and control participants were recruited to establish the reliability of TP EMG and the MSFoot model in the first phase of the study. A further cohort of RA patients with RA, PPV and ultrasound (US) confirmed tenosynovitis were recruited to determine the effect of targeting mechanics with customised foot orthoses (FO) and inflammation with a peri-tendinous corticosteroid injection. Results: Reliability of the MSFoot model was established barefoot and shod in five healthy controls and five patients with RA and PPV. Ten patients were recruited to the proof-of-concept study; all were issued with customised FO and four were issued with peri-tendinous corticosteroid injections in combination with FO. Differences between patients and controls were recorded across all domains. Mechanical and inflammatory intervention for three months did not significantly improve movement patterns, muscle activity or impairments and disability in the presence of highly active disease states. Improvements to levels of TP tendon pathology were recorded following targeted local corticosteroid intervention in this population. Results demonstrated response to intervention on an individual level due to high levels of disease activity. Conclusion: This study has provided an insight into muscle function in RA in the presence of active tendon disease and PPV. Suboptimal mechanics in this population are linked with increased muscle activity relative to healthy control participants and occur in conjunction with pathological tendon features on US. Technical and methodological issues adversely affected the results and the importance of disease related factors was highlighted.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available