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Background: Delay in treatment of rheumatoid arthritis (RA) is common in daily practice. It can be reduced if factors contributing to this delay are better known and if detection of RA is more effective. Objectives: To perform a literature review to give an overview of factors resulting in delayed general practitioner (GP) consultation in patients with RA and to describe and compare the detection tools for RA useful in the general practice. Methods: One researcher searched articles in PubMed, Embase, Web of Science and Cochrane using two different search strings in each database. Articles containing information about reasons for delayed GP consultation or about detection tools for RA or early inflammatory arthritis were selected. Results: After reading title, abstract and full text, 24 articles about factors associated with delayed GP consultation and 21 articles about detection tools useful in the general practice were selected for inclusion. Reasons for delayed GP consultation were summarised in 8 different themes: nature of the symptoms at the onset of RA, actions taken before consulting a GP, perceptions of the first symptoms, social factors, knowledge about RA, attitude towards GPs, accessibility of care and patient-related factors. Furthermore, 8 detection tools and 2 sets of classification criteria were found: Emery’s recommendation for early referral15, ‘clinical model’37 of Visser et al, referral criteria of Suresh38, ‘EIA Detection Tool’39, ‘Priority Referral Score’10, referral tool for IA of Alves40, ‘Advanced decision support tool’11 from Salmeron et al, ‘Clinical Arthritis RulE’41,1987 American College of Rheumatology criteria38 and 2010 ACR-EULAR criteria42. Comparison of the existing detection tools for RA is difficult, because different measures are used to evaluate the discriminative power of the tools (e.g. sensitivity, specificity, positive and negative likelihood ratio, area under the Roc curve and positive and negative predictive value) and because different outcomes are predicted with the tools (e.g. diagnosis of RA, future development of RA, need for referral to a rheumatologist, indication for treatment initiation, estimating the severity of RA...).   Discussion: Different factors associated with delayed GP consultation in patients with RA were identified and should be addressed. Increasing knowledge about RA in the general population and improving the communications skills of GPs could be possible ways to accomplish this. Future publications on detection tools for RA should aim for a more uniform reporting of the discriminatory value of the instrument for each proposed outcome.

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