Objective. To evaluate the relative contribution of gender‐related work conditions, gender‐related socialization practices, and disease characteristics to the explanation of emotional distress in men and women with rheumatoid arthritis (RA).

Methods. Three hundred sixty‐nine RA patients who were employed outside the home were recruited from a national randomized sample of rheumatology practices. Data on paid work and disease characteristics were obtained by telephone interview. Emotional distress was measured by the Center for Epidemiological Studies Depression (CES‐D) scale. Hierarchical ordinary least‐squares regression was used to assess the relationship of sex, class, work characteristics, and disease characteristics to both the CES‐D summary scale and the CES‐D factor structure.

Results. Differences in emotional distress were explained best by functional ability and pain and secondarily by the characteristics of paid work, with no independent effect for sex. Distress increased with decreasing functional ability, increasing pain, and exposure to such work characteristics as low autonomy, low income, and high demands. No sex differences in any of the CES‐D subscales remained after controlling for disease and work variables.

Conclusion. Among employed RA patients with high levels of functional disability and exposure to stressful work characteristics, men and women are at equal risk of experiencing emotional distress.