Objective. Occupational balance is a person's subjective perception of the amount and variation of their everyday activities. Evidence suggests an association between occupational balance and health. However, the impact of arthritis on occupational balance and its association with health is unclear. This exploratory study was undertaken to examine associations between occupational balance and measures of health and between-group differences in adults with and without inflammatory arthritis (IA).Methods. In a cross-sectional study, participants completed the 11-item Occupational Balance Questionnaire (OBQ-11) and the Short Form 36 (SF-36) health survey (physical and mental component summary scores) and provided demographic information. Telomere lengths were analyzed from dried blood spots.Results. A total of 143 adults participated (67 with IA, 76 from the healthy comparison [HC] group). Occupational balance was higher in the HC group than in the IA group (mean difference 3.5 [95% confidence interval 1.0, 5.9; P = 0.01]), but this difference was not statistically significant when adjusted for physical health. The association between occupational balance and physical health was stronger in the IA group (R 2 = 0.17, P = 0.001) than in the HC group (R 2 = 0.05, P = 0.05). Occupational balance was associated with mental health (R 2 = 0.26, P < 0.001) but not associated with telomere length (R 2 = 0.02, P = 0.24).Conclusion. Occupational balance is associated with mental health for all participants and associated with physical health and disease activity in participants with IA. Attention to assessment of and strategies for improving occupational balance in rehabilitation practice and arthritis self-management programs may contribute to sustaining physical and mental health.