People with rheumatoid arthritis (RA) who are work disabled report more pain and depression than do those who are able to continue in paid employment. This paper explores the connections between work ability, clinical disease factors and symptom reports among people with this chronic disease. Using the expanded Biopsychosocial model of disease and illness it is shown that both work ability and clinical factors have independent, additive effects on pain and depression. The paid work effect is found even after controlling for the large and significant effect of pain on depression and depression on pain. This suggests that the pain and depression experience associated with RA is a function of both the underlying disease and the structural barriers that prevent continued participation in the workplace. It also suggests that contrary to popular notions of how disease severity affects symptoms, one does not have to be in the highest categories of disease severity to be in the highest levels of depression and/or pain.