OBJECTIVES:   Chronic Inflammatory Rheumatic Diseases (CIRD), especially Rheumatoid Arthrits and Spondyloarthritis, are systemic inflammatory disorders significantly affecting patients’ quality of life. Disability and comorbidity associated to such conditions trigger high costs for healthcare systems and society. This analysis aims to measure direct costs in patients receiving pharmacological treatment. METHODS:   Using administrative healthcare claims from the Piedmont region in the North-West of Italy, we detected CIRD patients who, during the period Jan 2008 - Dec 2010, had >1 disease-modifying antirheumatic drug (DMARD) prescription, either synthetic (e.g. methotrexate) or biologic (e.g. infliximab). RD was confirmed if patients had >1 hospital diagnosis of CIRD (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, ICD-9 codes : 714.0, 696.0, 720.0) and/or an exemption code for similar diagnoses. Each patient was followed up from first DMARD prescription (index date) for three years or until death. RESULTS:   In the selected period N=12,455 patients with CIRD diagnosis received DMARD. Patients were mainly female (58.1%), with a mean age of 55.3 (+17.4) years. Direct annual costs were €6,983, €4,974, €5,178, during Year 1, 2, 3. The composition of average annual costs was: €1,531 (26.8%) for hospital costs and emergency room costs, €163 (2.9%) for synthetic DMARDs, €2,188 (38.3%) for biologic DMARDs, €985 (17.2%) for concomitant medications, €845 (14.8%) for ambulatory visits. N=4,670 (37.5%) received biologic therapy during the follow-up. CONCLUSIONS:   Chronic Inflammatory Rheumatic Diseases determine a relevant economic burden for healthcare services, because of significant epidemiological impact and high per-patient costs. Costs are significantly high at every stage of disease, both at time of diagnosis, and over time.