Rare co-existance of disease or pathology Background: Multifocal superficial thrombophlebitis is a rare clinical manifestation with wide differential diagnosis in relation to the background disease. Case Report: Here we report on 2 patients who presented with a systemic inflammatory response, multifocal thrombophlebitis, and orbital inflammation in whom a diagnosis of a defined background disease could not be established. Conclusions: The clinical pattern of our 2 cases might represent a distinctive, not yet defined systemic medical condition.

BackgroundIn patients with rheumatoid arthritis (RA), early diagnosis and adherence to the treat to target recommendations (T2T) limit RA progression and improve patients’ quality of life.1 However, the implementation of T2T has always been a challenge, and real-life data are lacking. Slovenia has 40% less rheumatologists per capita than the European Union average, which makes the implementation of management guidelines even more challenging.ObjectivesTo determine the incidence of RA and the proportion of patients with incident RA in whom first rheumatology assessment was done within the recommended time frame.MethodsWe analysed the prospectively collected data of adult patients diagnosed with RA during years 2014 to 2016 at the Rheumatology Department of the University Medical Centre Ljubljana, Slovenia. The department provides rheumatology services to a well-defined region with a population of 704.000 adult residents. Dates were recorded for inflammatory joint symptom onset, referral to rheumatologist, first rheumatologic assessment and initiation of DMARD therapy. The percentage of patients assessed by a rheumatologist and/or treated with a DMARD within 12 weeks of symptom onset and the median times for delay were then calculated.ResultsBetween 1 January 2014 and 31 December 2016, 341 incident cases of RA (75% females, median age 61.9 (IQR 52–75.4) years) were identified, resulting in an annual incidence rate of 16/100.000 population (in females: 23.6/100.000; in males 8.3/100.000). Most patients (78.6%) were referred to our early interventional clinic. The median time from symptom onset to consultation was 12.9 (IQR 4.4–26.1) weeks, median time from referral to consultation was 1 (IQR 1–3) day. Median DMARD treatment delay was 16.6 (IQR 8.9–33.3) weeks. Within 12 weeks of symptom onset, 161 (47.2%) new RA patients were examined by a rheumatologist and 123 (36.1%) were started on DMARD therapy.ConclusionsOur prospective data support the recent reports that uncovered a decrease in RA incidence.2 Moreover, despite the lack of rheumatologists and the heavily protracted nationwide waiting times for first rheumatologist assessment, our early interventional clinic enables us to recognise and manage substantial percentage of RA patients within the recommended time frame.References[1] Monti S, et al. Rheumatoid arthritis treatment: the earlier the better to prevent joint damage. RMD Open2015;1(Suppl 1):e000057. doi:10.1136/rmdopen-2015-000057[2] Abhishek, et al. Rheumatoid arthritis is getting less frequent—results of a nationwide population-based cohort study. Rheumatology2017;56:36–744–7.Disclosure of InterestNone declared

BackgroundIn early rheumatoid arthritis (RA), first assessment by a rheumatologist and/or initiation of disease-modifying anti-rheumatic drugs (DMARD) within 12 weeks of symptom onset are associated with a significant benefit in long-term disease outcome.1,2ObjectivesTo determine the proportion of patients with newly diagnosed RA in whom first rheumatology assessment and/or initiation of DMARD therapy was within the desired time frame.MethodsA retrospective chart review of adult patients diagnosed with RA during year 2014 and the first half of year 2015 was performed at our rheumatology department, which is a part of an integrated secondary/tertiary teaching hospital that provides rheumatology services for a population of more than 500.000 residents. Potential cases were identified by searching the electronic medical records for ICD-10 codes M05.* and M06.* Electronic and paper records of patients were then thoroughly reviewed. Dates were recorded for onset of inflammatory joint symptoms, referral to rheumatologist, initial assessment by a rheumatologist and initiation of DMARD therapy. The percentage of patients assessed by a rheumatologist and/or treated with a DMARD within 12 weeks of symptom onset and the median times for delay were then calculated.ResultsBetween 01.01.2014 and 30.06.2015, 188 new cases of RA were identified at our Department of Rheumatology. Of those, 153 (81.4%) were referred to our early interventional clinic. Within 12 weeks of symptom onset, 89 (47.3%) new RA patients were examined by a rheumatologist and 68 (36.2%) were started on DMARD therapy; the median time from symptom onset to consultation was 12.8 (IQR 4.9–27.7) weeks, median time from referral to consultation was 1 (IQR 1–3) day and median DMARD treatment delay was 16.1 (IQR 8.6–32.8) weeks.Table 1.Demographic data, clinical history, and delaysGender (female/male) (%)143/45 (76/24)Age, years (mean ± SD)62.4±15.4DAS28 3v (mean ± SD)5.3±1.3Patients fulfilling 2010 ACR/EULAR classification criteria for RA, # (%)177 (94.1)Time from symptom onset to first rheumatologist assessment, weeks (median)12.8 (IQR, 4.9–27.7)Time from referral to first rheumatologist assessment, weeks (median)0.14 (IQR, 0.14–0.43)Time from symptom onset to glucocorticoid initiation, weeks (median)13.0 (IQR, 5.8–27.2)Time from symptom onset to DMARD initiation, weeks (median)16.1 (IQR, 8.6–32.8)Legend: SD: standard deviation, IQR: interquartile range.Conclusions47% of new RA patients were assessed by a rheumatologist and 36% were treated with a DMARD within the recommended time frame of 12 weeks. Most of the treatment delay was due to the time elapsed between symptom onset and referral to a rheumatologist. These results substantiate the efficacy of our early interventional clinic in diagnosing and treating patients with early RA: despite the heavily protracted nationwide waiting times for first rheumatologist assessment and significantly (40%) lower number of rheumatologists per capita compared to European Union average, the percentage of timely treated patients...