To assess the diagnostic correlation between primary care physicians and rheumatologists in patients with temporary work disability (TWD) related to musculoskeletal diseases (MSD). All patients with TWD related to MSDs in three health districts of Madrid, Spain, were randomized into standard care by primary care physicians (PCP) or the intervention group by rheumatologists. According to the cause, every TWD episode was classified into 11 syndrome categories. To examine the concordance between the rheumatologist and the referring PCP for each diagnosis, we used Kappa statistic (k) and 95% confidence interval (CI). A total of 3,311 (62.8%) were analyzed, 49.8% women, with a mean age of 41 years ± 12 years, 93.3% were general workers. The agreement between PCP and rheumatologists in all the diagnoses was moderated (k = 0.62). The highest agreement was found in tendonitis (k = 0.81, 95% CI 0.78-0.84), and microcrystalline and undifferentiated arthritis (k = 0.72, 95% CI 0.68-0.77). Lowest agreements were found for peripheral osteoarthritis (k = 0. 48 95% CI 0.38-0.57), knee pain (k = 0.40, 95% CI 0.29-0.52), and muscular pain (k = 0.15, 95% CI 0.10-0.20) Although the global agreement on the musculoskeletal diagnosis between PCPs and rheumatologist in patients with TWD related to MSDs was reasonable, the correlation for peripheral osteoarthritis, knee pain, and muscular pain was low.