OBJECTIVE: To evaluate the cross-cultural measurement equivalence of the US and Dutch Health Assessment Questionnaire II (HAQ-II) in rheumatoid arthritis (RA). METHODS: Item response theory (IRT) analyses were performed on US (n=18747) and Dutch (n=1022) HAQ-II data to evaluate the equivalence of cross-cultural item performance. Observed inconsistencies were modeled by assigning country-specific item parameters to biased items. The impact of cross-cultural item bias on the comparability of the Dutch and US total scores was analyzed by evaluating the agreement between physical function levels estimated from an IRT model with country specific-item parameters for biased items and the physical function levels estimated from the original model that does not account for cultural bias. RESULTS: Two items showed significant cross-cultural bias. However, the agreement in physical function estimates between the respecified and original model was very high with ICC >0.99 and the Bland–Altman limits of agreement ranging from -0.08 to 0.07 on a latent scale with a mean of 0 and standard deviation 1. CONCLUSIONS: This study suggests that the Dutch and US HAQ-II produce total scores that can be interpreted interchangeably across countries in RA studies, despite some minor bias at the item level.