Inflammatory rheumatic diseases are major contributors to morbidity and healthcare utilisation worldwide. Advances in disease-modifying antirheumatic drug therapy have substantially changed disease management and may have influenced patterns of inpatient care and orthopaedic surgical treatment. However, nationwide data on long-term hospitalisation trends remain limited. This nationwide analysis of aggregated inpatient hospital discharge data was based on data from the German Federal Health Monitoring system (GBE-Bund) between 2010 and 2023. Hospitalisations associated with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and osteomyelitis were identified using ICD-10-GM codes. Orthopaedic procedures were analysed using diagnosis-related group data from the German Institute for the Hospital Remuneration System (InEK). Hospitalisation trends differed substantially across disease groups. RA hospitalisations declined from 29,775 cases in 2010 to 24,992 cases in 2023 (− 16.1%), while JIA showed the largest reduction (− 43.0%). In contrast, PsA hospitalisations increased (+ 7.6%), whereas AS remained largely stable (+ 2.9%). Osteomyelitis, included as a comparator musculoskeletal disorder, showed an overall stable pattern. A marked reduction in hospitalisations was observed across all disease groups in 2020. Age-standardised hospitalisation rates largely mirrored these findings, with RA decreasing from 40 to 30 and JIA from 7 to 4 hospitalisations per 100,000 population between 2010 and 2023. Distinct orthopaedic procedure profiles were identified, with knee and hip replacement procedures predominating in RA and spine-related interventions predominating in AS. Nationwide hospitalisation patterns in inflammatory rheumatic diseases have changed substantially over the past decade. Despite advances in medical therapy, orthopaedic surgical interventions continue to represent an important component of disease management, highlighting the continued need for integrated rheumatologic and orthopaedic care.