Patients with rheumatoid arthritis (RA) are at risk of work disability from the very start of their symptoms. Prospective cohorts including patients with early RA show that 20-30% become permanently work disabled during the first 2-3 years of the disease. Risk factors for early work disability include a physically demanding job, older age, and lower educational level, as well as the level of functional disability in daily activities. Work disability accounts for a major fraction of the costs of RA both to the patient and to society. Improved work disability outcomes in RA may require attention to social, economic, and political issues, and broader physician and public education concerning RA, in addition to improved medical management of the disease.