In the next 12 months, 7500 Canadians and 75,000 Americans will be afflicted with the onset of rheumatoid arthritis. Little is known about the health care use of patients with early RA. Nonetheless, rheumatologists and outcomes researchers strongly endorse the need for early diagnosis and treatment of this population. This article reviews trends and impediments to early referral of new-onset arthritis patients. The slow growth of early arthritis clinics is summarized in a survey that characterizes 23 early arthritis programs in North America. Also, several screening tools and models to capture these early-onset arthritis patients are presented.