ENStiff hands in the morning that do not loosen up for an hour, swollen finger joints on both hands, constant tiredness – this is how rheumatoid arthritis often begins. It is an autoimmune inflammation: the immune system attacks the inner lining of the joint. Without treatment, the inflammation damages cartilage and bone.
The aim of treatment today is remission, meaning the disease is inactive: joints neither hurt nor swell, and blood tests show no inflammation. Where remission cannot be reached, the target is at least low disease activity. A trip to a German rheumatologist makes sense if the diagnosis is unclear, the disease stays active despite treatment, a biologic has to be chosen, or the inflammation has affected the lungs, blood vessels or other organs. This page explains rheumatoid arthritis treatment in Germany: diagnosis, medicines, surgery, doctors and clinics.
How rheumatoid arthritis is diagnosed
A rheumatologist makes the diagnosis from the examination, blood tests and joint imaging. The doctor counts how many joints are painful and how many are swollen, and notes which ones: rheumatoid arthritis typically affects small joints of the hands and feet on both sides. Time matters: the first months of the disease are called a “window of opportunity”, when treatment works particularly well and can stop the inflammation before it harms the joint.
The key blood tests are rheumatoid factor and antibodies against cyclic citrullinated peptide (anti-CCP). Rheumatoid factor also occurs in other diseases and in some healthy people, so it is not enough on its own. Anti-CCP antibodies target the body’s own proteins that have been slightly altered chemically, and they point fairly reliably to rheumatoid arthritis. ESR and C-reactive protein show how strong the inflammation is but do not prove the diagnosis. Joint ultrasound shows the inflamed lining before changes appear on X-rays. X-rays of the hands and feet are standard, with MRI where needed.
Arthritis treatment starts with the question of which arthritis it is: rheumatoid arthritis, psoriatic arthritis, gout – or osteoarthritis, which is wear of the cartilage rather than inflammation. These are different diseases, and they are treated differently; for osteoarthritis, see the page on joint treatment in Germany.
Treat-to-target: how therapy is adjusted
Treat-to-target means that doctor and patient agree on a goal – remission or at least low disease activity – and check at every visit whether it has been reached. Activity is measured on a scale such as DAS28, which combines tender and swollen joints, a blood test for inflammation and the patient’s own assessment of how they feel into one score. If the goal is not reached, treatment is changed without waiting for months. This is how the German Society for Rheumatology (DGRh) guideline on drug therapy for rheumatoid arthritis describes the principle in its current 2026 version.
Conventional disease-modifying drugs suppress the inflammation itself, not just the pain. The usual first step is methotrexate. Corticosteroids are added briefly at the start: they act quickly, bridge the gap until the conventional drug takes effect, and are then stopped. If that is not enough, biologics or tablets follow. TNF inhibitors block one of the main signalling proteins of inflammation. Interleukin-6 blockers switch off another such signal. Abatacept stops T cells, which drive the inflammation, from being activated. Rituximab reduces the number of B cells, which help produce antibodies. JAK inhibitors are tablets that interrupt inflammatory signals inside the cell; they are an alternative once the individual risks have been weighed.
Safety is part of the plan from the start. Before biologic therapy, patients are screened for hidden tuberculosis and hepatitis, and vaccinations are brought up to date. Regular blood tests during treatment show early how the drug affects the blood, liver and kidneys. Pregnancy plans are discussed with the rheumatologist in advance, as not every drug is compatible with pregnancy.
Beyond medication: physiotherapy, occupational therapy, surgery
Besides medication, physiotherapy, occupational therapy and sometimes surgery help. Exercise therapy keeps joints mobile and muscles strong. Occupational therapists teach everyday movements that protect the joints and fit splints that support them. When the disease is highly active, inpatient multimodal rheumatology treatment (rheumatologische Komplextherapie) is an option: several weeks in which the rheumatologist, physiotherapists and occupational therapists follow one programme.
Surgery is needed when a joint is destroyed or the inflamed lining does not respond to treatment: the lining is removed (synovectomy), a destroyed joint is replaced, and the hand and foot can be operated on. Rheumatoid arthritis and corticosteroids raise the risk of osteoporosis, or fragile bones; see the page on osteoporosis treatment.
Rheumatologists and clinics in Germany
In Germany, rheumatoid arthritis is treated by rheumatologists at university hospitals and specialised centres. Prof. Reinhard E. Voll has headed the Department of Rheumatology and Clinical Immunology at Freiburg University Hospital since 2010. Prof. Martin Aringer is deputy director of Medical Clinic III at Dresden University Hospital and a rheumatologist. Erlangen University Hospital has Medical Clinic 3 – Rheumatology and Immunology.
ATOS Klinik Heidelberg has a centre for rheumatology that also covers paediatric and adolescent rheumatology. Sana Klinikum Offenbach has Medical Clinic III – Nephrology, Rheumatology and Hypertensiology, which treats kidney diseases, rheumatic diseases and high blood pressure. Rheumatoid arthritis in children is a separate topic, covered on the page on juvenile arthritis.
Frequently asked questions
How is rheumatoid arthritis treated in Germany?
In Germany, treatment starts as soon as the diagnosis is confirmed: first with conventional disease-modifying drugs, usually methotrexate, then, if the goal is not reached, with biologics or JAK inhibitors. Disease activity is measured regularly and treatment adjusted accordingly. Care is led by rheumatology centres at university and specialised hospitals, where physiotherapists and occupational therapists work alongside the rheumatologist; severe cases may receive inpatient multimodal treatment.
Which country is best for rheumatoid arthritis treatment?
There is no single winner: what matters is where and how treatment is run. Two criteria are worth checking. First, is there a rheumatology centre that treats rheumatoid arthritis regularly, measures disease activity and changes treatment in good time? Second, is there access to biologic therapy if conventional drugs are not enough? It is also worth finding out in advance whether the treatment can be continued at home, since the disease needs years of follow-up.
Can rheumatoid arthritis be cured?
Rheumatoid arthritis cannot yet be cured completely: it is a chronic disease. But it can be calmed for a long time – the aim of treatment is remission, when the disease is inactive, or at least low activity. Even in lasting remission, the DGRh guideline does not advise stopping disease-modifying therapy altogether; the dose may only be reduced gradually under a rheumatologist’s supervision. Treatment is therefore long-term and continues after returning home.
How AlenMed arranges rheumatoid arthritis treatment
AlenMed handles the paperwork, contact with the clinic’s rheumatologist and the trip. Before the trip, we translate medical reports, blood results (with dates and units), images on disc and a list of all medicines with doses, and send them to the rheumatologist of a suitable clinic. The doctor proposes a plan – an outpatient assessment or inpatient multimodal treatment – and the clinic issues an official cost estimate (Kostenvoranschlag). More on the page on arranging treatment in Germany.
We arrange the visa invitation and accommodation and provide an interpreter at appointments. AlenMed’s office is in Munich, and partner clinics are across Germany.
After returning home, the patient receives a report in their own language with the treatment plan and the blood test schedule, and we help keep in touch with the German doctor. It is worth clarifying in advance whether the prescribed drug is available at home.
This material is for reference only and is not an offer. Treatment is decided by the doctor after an in-person examination.