Objective. Job loss is a major consequence of rheumatic diseases, and clinicians may refer patients to vocational rehabilitation for help. When provided after job loss, the impact of vocational rehabilitation is short term. This randomized controlled trial with 48 months of followup was undertaken to determine the efficacy of vocational rehabilitation provided to persons with rheumatic diseases while they are still employed, but at risk for job loss.Methods. A total of 242 patients with rheumatic diseases residing in Massachusetts were recruited through their rheumatologists for study. Participants were randomly assigned to the experimental group (n ؍ 122) or the control group (n ؍ 120). Subjects in the experimental group received two 1.5-hour sessions of vocational rehabilitation; those in the control group received print materials about disability employment issues and resources by mail. The main outcome assessed was the time to first job loss. Job losses were defined as permanent disability, premature retirement, or a period of unemployment. All analyses were conducted on an intent-to-treat basis.Results. Job loss was delayed in the experimental group compared with the control group (P ؍ 0.03 by log rank test). After adjustment for confounders, participation in the experimental group was found to be protective against job loss (odds ratio 0.58 [95% confidence interval 0.34-0.99], P ؍ 0.05 by pooled logistic regression).Conclusion. Vocational rehabilitation delivered to patients at risk for job loss, but while they were still employed, delayed job loss. Such an intervention has the potential to reduce the high indirect costs, as well as the personal impact, of rheumatic diseases.Health-related job loss is a major consequence of rheumatic diseases. In the most recent analyses (1), costs stemming from lost wages, so-called indirect costs, for all forms of arthritis were 74% of the total costs, while the direct costs of medical care were 26% of the total. This burden can be expected to increase because the portion of the US work force that is 55 years of age and older is increasing (by 2020, it will account for one-fifth of the work force) (2) and because the incidence and prevalence of many rheumatic diseases rise substantially after age 50 years. Health-related job loss also exacts a substantial toll on the quality of life of individuals, being associated with lower levels of self-esteem, life satisfaction, adaptation, perceived health status, and in those with rheumatoid arthritis, higher levels of depression and pain (3-5).Vocational rehabilitation is one approach to addressing health-related job loss. Rheumatologists and other clinicians may wish to refer their patients with rheumatic diseases to vocational rehabilitation for help. However, there is a shortage of studies evaluating the effectiveness of vocational rehabilitation. Studies that have been done suggest that while it can be effective in helping persons with disabilities regain employment, this effect is often short-lived (6). Moreover, the...