The article presents a clinical case of systemic scleroderma and polymyositis in a young female patient. Notable is a rather rapid development of symptoms beginning with Raynaud’s syndrome, scleroderma skin lesion, and visceral pathology against the background of immunologic activity. Along with this, there were signs of polymyositis: weakness of proximal muscle groups, high indices of muscle enzymes, and positive electromyographic data. After SARS-CoV-2 vaccination, the patient noted a worsening of her general condition, increased muscle weakness and the appearance of new symptoms such as dysphagia, dysphonia, enlarged cervical lymph nodes, shortness of breath, and cough. The examination revealed vocal fold paralysis, paresis of the right side of the larynx and soft palate, and pulmonary hypertension. The results of the examination of the muscular component implied a primary muscular lesion.

The purpose — to assess the early imaging changes in the atlantoaxial area and to compare them with clinical and laboratory characteristics in patients with ankylosing spondylitis (AS). Material and methods. 20 patients with AS were examined, the average age is 44.2 ± 12.66 y. o. Activity (ASDAS(CRP)): very high — 85%, high — 5%, low — 10%. X-ray stage of sacroiliitis: 2 — 60%, 3 — 15%, 4 — 25%. Functional deficiency (FD): 3 — 55%, 2 — 20%, 1 — 25%. The duration of illness was 176 [2; 360] months. The extended clinical examination included: assessment of neurological status, presence of components of neuropathic pain (NP) and central sensitization (CS), assessment of quality of life, degree of functional disorders. Magnetic resonance imaging (MRI) of the craniovertebral junction was performed with the measurement of 5 craniometric parameters (CMP) for the presence of translocation of the dens axis. Results. Neck pain syndrome — 75%: inflammatory — 95%, non-inflammatory — 80% (NP — 65%, CS — 50%). VAS: 5.75 ± 2.09. FD: BASMI — 3.86 [2; 7], BASFI — 4,84 [0,7; 8,7]. 75% — limitation of neck rotation, 65% — increase in the distance of the trestle-wall. CMP: 100% — decrease in the retroflex angle, 20% — increase in the anterior atlantodental index, 15% — translocation relative to the Chamberlain line, 10% increase in pB-C2, 5% — decrease in the posterior atlantodental index. A correlation was revealed between the CMP with the X-ray stage (rSp = 0.629; p = 0.021), BASMI (rSp = 0.575; p = 0.04) and the psychological component SF-36 (rSp = 0.570; p = 0.042). The angle of retroflexion with the duration of the disease (rSp = -0.580; p = 0.038), CRP (rSp = 0.624; p = 0.023). Conclusions. All patients with AS had pathological MRI changes in the form of initial manifestations of translocation of the dens, which had nonspecific clinical manifestations. Changes in craniovertebral transition to MRI did not correlate with disease activity (ASDAS (CRP)), but were associated with the level of CRP, duration of the disease, X-ray stage of sacroiliitis and functional indices (BASMI).