OBJECTIVES The aim of the study is to estimate the pension costs (social security system in Italy is financed by public expenditure) induced by patients with musculoskeletal disorders (MD) and specifically for rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in Italy, between 2009 and 2012. METHODS We analysed the database of National Institute of Social Security (INPS) to estimate for MD, RA, AS and PsA, the total costs of for three types of social security benefits: disability benefits (for people with reduced work ability), disability pensions (for people who are not eligible to be considered as workers) and incapacity pensions (for people without work ability). Also was estimated the productivity loss for RA in the 2013 with data from the National Institute of Statistics and from national literature review. RESULTS From 2009 to 2012 were paid about 320 thousand benefits at a cost of approximately €1.7 billion, for an average of just over 80,000 performances a year with a cost of € 432 million per year. Specifically the total pension burden for RA was about €99 million, for AS was €26 million and for PsA was €12 million. The loss of productivity for AR in 2013 amounted to € 707,425,191 due to 162,360 workers with RA that determine 9,174,221 working days lost. CONCLUSIONS The most important indirect costs in Italy from 2009 to 2012 was represented by disability benefits (69% of the total indirect cost), followed by disability pensions (28% of cost) and incapacity pensions (3% of cost). A better prescription appropriateness and rapid access to innovative treatments (Italy, among the EU Countries, is the one with the greatest delay in access) would reduce the costs incurred by the social security system accompanied by an improvement on the effectiveness of interventions.