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We read with interest the article by Gupta et al 1 who reported the management of treatments for rheumatic diseases during COVID-19 pandemic among practitioners in India. In this study, the authors showed that about half of the physicians would reduce the use of biological disease-modifying antirheumatic drugs (bDMARDs) or defer specific drugs such as rituximab.1 Choices were apparently made considering possible relationships between drug mechanism of action and effect on the viral infection.1 During COVID-19 pandemic, telemedicine is emerging as a possible tool for reducing the risk of contagion and viral spread,2–4 and a useful strategy for the management of chronic diseases.5 6 As of 29 April 2020, the outbreak of COVID-19 generated 201 505 confirmed cases in Italy, with 2405 confirmed cases in Naples Metropolitan area. The objective of our study was to evaluate telemedicine when offered as part of routine care for the follow-up of patients …

Coexistence of orbital cavernous hemangioma and other vascular malformations is unusual and few cases have been reported. We describe the clinical and radiological features of three cases of orbital cavernous hemangiomas associated with other vascular malformations, selected reviewing a series of 181 cases of cavernous hemangiomas. All patients were males (age ranging from 43 to 67 years) without vascular systemic disorders and/or a clinical syndrome. They experienced slow progressive exophthalmos. One of them developed acute pulsatile proptosis (case 2), while another experienced slow progressive diplopia (case 3). In one case vascular lesions were bilateral (case 3) and in two patients two different lesions coexisted in the same orbit (cases 1 and 2). All patients underwent surgical excision, which was partial in two cases. Two patients had cavernous hemangiomas in association with a venous malformation (a varix in case 1 and a lymphangioma in case 2), while in the other ones (case 3) cavernous hemangioma was associated with a low-flow arteriovenous malformation. No patient denied visual impairment postoperatively. Few cases of orbital cavernous hemangiomas coexisting with other vascular malformations have been reported in the literature. This entity seems to be an association of different variants of orbital vascular malformations, presenting with a wide spectrum of clinical forms and probably with the same pathogenesis.

Spondyloarthropathy refers to a group of articular inflammatory diseases that share common genetic, clinical and radiological features in addition to their association with human leucocyte antigen (HLA)-B27 antigen. The aim of therapeutic management of patients with spondyloarthritis is to improve quality of life, control the symptoms of articular inflammation, prevent the structural damage of joints, and preserve the functional abilities, autonomy and social participation of patients. Although disease-modifying anti-rheumatic drugs demonstrate some benefit in the treatment of peripheral arthritis, they have shown to be ineffective for the treatment of patients with axial disease. Biological therapies and new imaging techniques have changed the therapeutic and diagnostic approach to spondyloarthritis. In patients with axial spondyloarthritis for whom conventional therapy with non-steroidal anti-inflammatory drugs has failed, TNFα-inhibitor treatment is currently the only effective therapy. It is more effective in preventing articular damage in peripheral joints compared with joints of the spine. The aim of this review is to summarise the current evidence for treating ankylosing spondylitis and non-radiographic axial spondyloarthritis with TNFα-inhibitor.