OBJECTIVES: Rheumatoid Arthritis (RA) imposes a significant burden of disease to both affected patients and the society as a whole. We performed the first German claims database analysis among members of a statutory health insurance fund to estimate RA treatment prevalence, to describe prescription patterns and assess overall disease burden. METHODS: We based our analysis on billing data from the years 2000 to 2004 of a German sickness fund covering 1.5 million beneficiaries. RA patients were identified by either inpatient or sick leave records due to ICD-10 codes (M05, M06) or at least two prescriptions of a disease-modifying drug (DMARD) or a TNF-a inhibitor. We excluded patients with a variety of co-medications and diagnoses, e.g. Psoriasis, Crohn's Disease and malignant disease. We specified treatment prevalence and patterns of RA disease management with DMARDs and TNFs in the selected population. RESULTS: Out of the 728,111 beneficiaries continuously enrolled between 2000 and 2004 n = 5,850 (mean age: 43 ± 14 years) fulfilled the inclusion criteria for RA. RA treatment prevalence, standardized to the general German population was 0.68 % for men and 1.25 % for women. 43% of the patients with RA were treated with DMARDs and 3.2% received TNF-a inhibitors. 26% of RA-patients were initiated on DMARD therapy by a general practitioner. Compared to the RA population as a whole patients receiving TNF-a inhibitors were characterized by a 2.6 fold number of sick leaves and a 6.4 fold number of hospitalizations in the year prior to therapy initiation. CONCLUSION: The RA treatment prevalence found in this study is in line with local epidemiological research. As less than half of RA-patients had a prescription of a DMARD, this may indicate that therapeutic standards are not met. TNF-a inhibitors are mainly prescribed in a high burden RA subpopulation.