The role of muscle in the susceptibility and progression of axial Spondyloarthritis: The MyoSpA Study Protocol.

BACKGROUND: Axial Spondyloarthritis (axSpA) is a chronic, inflammatory rheumatic disease that affects the axial skeleton, causing pain, stiffness, and fatigue. Genetics and environmental factors such as microbiota and microtrauma are known causes of disease susceptibility and progression. Murine models of axSpA found a decisive role for biomechanical stress as an inducer of enthesitis and new bone formation. Here, we hypothesize that muscle properties in axSpA patients are compromised and influenced by genetic background. OBJECTIVES: To improve our current knowledge of axSpA physiopathology, we aim to characterize axial and peripheral muscle properties and identify genetic and protein biomarker that might explain such properties. METHODS: A cross-sectional study will be conducted on 48 participants aged 18-50 years old, involving patients with axSpA (according to ASAS classification criteria, symptoms duration < 10 years) and healthy controls matched by gender, age, and levels of physical activity. We will collect epidemiological and clinical data and perform a detailed, whole body and segmental, myofascial characterization (focusing on multifidus, brachioradialis and the gastrocnemius lateralis) concerning: a) Physical Properties (stiffness, tone and elasticity), assessed by MyotonPRO®; b) Strength, by a dynamometer; c) Mass, by bioimpedance; d) Performance through gait speed and 60-second sit-to-stand test; e) Histological and cellular/ molecular characterization through ultrasound-guided biopsies of multifidus muscle; f) Magnetic Resonance Imaging (MRI) characterization of paravertebral muscles. Furthermore, we will perform an integrated transcriptomics and proteomics analysis of peripheral blood samples. DISCUSSION: The innovative and multidisciplinary approaches of this project rely on the elucidation of myofascial physical properties in axSpA and also on the establishment of a biological signature that relates to specific muscle properties. This hitherto unstudied link between gene/protein signatures and muscle properties may enhance our understanding of axSpA physiopathology and reveal new and useful diagnostic and therapeutic targets.

Intervenção do enfermeiro especialista em enfermagem de reabilitação: prehabilitation da pessoa proposta para cirurgia ortopédica / Intervention of the specialist nurse in rehabilitation nursing: prehabilitation of the person proposed for orthopedic surgery

O ato cirúrgico comporta um stress fisico e psicológico para a pessoa que se submete ao mesmo, quer esta esteja ou não em condições para o enfrentar. Posto isto, acreditamos que a pessoa proposta para uma cirurgia deve ser abordada no âmbito da sua capacitação para enfrentar as consequências do ato cirúrgico. Propomos assim o estabelecimento de um programa de prehabilitation, que se define por um processo de potenciação da capacidade funcional da pessoa no periodo préoperatório. O presente relatório pretende assim caracterizar a possibilidade de o enfermeiro especialista em enfermagem de reabilitação desenvolver intervenções autónomas no âmbito da prehabilitation. Tratando-se de um relatório de estágio pretendemos também demonstrar, através das intervenções desenvolvidas, o desenvolvimento das competências enunciadas nos Descritores de Dublin para o 2º ciclo de ensino, o desenvolvimento das competências especificas do enfermeiro especialista em enfermagem de reabilitação e das competências comuns do enfermeiro especialista, preconizadas pela Ordem dos Enfermeiros. Como teoria orientadora das intervenções realizadadas foi adotada a Teoria do Défice de Autocuidado em Enfermagem de Orem, uma vez que a capacidade de autocuidado se encontra diretamente ligada à capacidade funcional. Foi desenvolvida uma Revisão Narrativa da Literatura utilizando a metodologia PICo, com o intuito de identificar as intervenções supracitadas. O processo de investigação permitiu-nos identificar os principais objetivos do processo de prehabilitation sendo estes: aumentar a capacidade de exercício, aumentar a massa muscular, melhorar o estado nutricional e preparar a condição psicológica. Comprovou-se que o estado fisiológico basal da pessoa é um importante fator que afeta o resultado cirúrgico e que os fatores de risco modificáveis podem ser abordados antes da cirurgia. As intervenções a implementar inserem-se maioritariamente sob o exercício físico e a sua tolerância, mas também sob a melhoria da função respiratória, através de uma ação profilática com o treino dos músculos inspiratórios e com uma higiene brônquica eficaz.

The surgical procedure involves physical and psychological stress for the person who submits to it, whether they are able to face it or not. That said, we believe that the person proposed to a surgery must be approached in the ambit of training to face the consequences of a surgical act. We therefore propose the establishment of a prehabilitation program, which is defined by a process of enhancing the person's functional capacity in the preoperative period. This report intends to characterize the possibility of a nurse specialist in rehabilitation nursing to develop autonomous measures in the scope of prehabilitation. In the case of an internship report, we also intend to demonstrate, through the skills developed, the development of the competencies set out in the Dublin Descriptors for the second teaching cycle, the development of the specific skills of the nurse specialist in rehabilitation nursing and of the common specialist nurse skills , recommended by the Ordem dos Enfermeiros. As the guiding theory of the interventions performed, Orem's General Theory of Self-Care was adopted, once the capacity for self-care is directly linked to functional capacity. A Narrative Literature review was developed using the PICo methodology, in order to identify the aforementioned measures. The common investigation process allows us to identify the main objectives of the prehabilitation process, namely: increasing exercise capacity, increasing muscle mass, improving nutritional status and psychological preparation. It has been proven that the person's baseline physiological status is an important factor that affect surgical outcome, and that modifiable risk factors can be controlled before surgery. The interventions to be implemented are mostly under physical exercise and tolerance, but also under the improvement of respiratory function, through a prophylactic action, with the training of inspiratory muscles and with effective bronchial hygiene.