Rheumatology continues to be an exciting and vibrant specialty for specialists practising in New Zealand and Australia. Clinicians follow treat-to-target regimens to manage peripheral and axial inflammatory arthritides using conventional and biological agents, which have revolutionised management of rheumatic disease over the past two decades. However, optimal clinical practice has significant pharmacoeconomic implications which impact on health funding at a national level, and the advent of biosimilars is keenly awaited. The management of non-inflammatory rheumatic disease and the lack of effective disease-suppressing pharmacologic therapy for osteoarthritis continue to challenge clinicians. We are fortunate in having world-class rheumatology research in our region with basic scientists and clinical rheumatologists spearheading investigations, the ultimate aim of which is to improve the quality of life for our patients.