OBJECTIVES: The relationship between out-of-pocket (OOP) healthcare costs with productivity is not well known.  This study explores the relationship of OOP healthcare costs on productivity. METHODS: Participants self-identified with RA and aged ≥18 completed an internet-based cross-sectional survey in 1Q2009. Self-reported productivity loss including absenteeism, presenteeism, overall work impairment and activity impairment expressed as impairment percentages, were measured by the Work Productivity and Activity Impairment questionnaire. Participants were asked about RA-related and overall monthly OOP healthcare costs. Negative binomial regression models were developed to adjust for age, gender, ethnicity, income, education, and marital status. RESULTS: 455 RA patients participated in the survey. Average age was 52 years, 67% were female, 36% were employed, and 23% were on short- or long-term disability. More than half (53%) reported annual household incomes between $50-100K, and 30% were college educated. Overall monthly OOP costs were:  $0-$50 for 54.1%, $51-$100 for 19.3%, $101-$200 for 15.8%, and >$200 for 10.8%. Among employed patients, the rates of absenteeism, presenteeism, and overall work impairment were 13.7%, 23.7% and 28.9%, respectively. Both employed and unemployed patients reported 58.4% impairment in daily activities. Significantly greater productivity loss (presenteeism, b = 1.01, p = 0.038) and activity impairment (b = 0.21, p = 0.006) were observed among patients with overall OOP costs >$200, and significantly greater activity impairment was observed among the OOP costs category of $101-200 (b = 0.15, p = 0.026) as compared to those with OOP costs between $0-50 after adjusting for patient demographics.  CONCLUSIONS: Higher monthly OOP costs were associated with higher activity impairment and lower productivity; however, due to cross-sectional study design, direction of associations cannot be determined. Shifting healthcare costs to employees may be associated with productivity loss. Further research is needed to determine long-term impact of OOP healthcare costs on work productivity.