The initiation and perpetuation of many rheumatic diseases is believed to be mediated by specific T-cells activated by an unknown antigenic peptide present on the surface of antigen presenting cells (APC). The T-cell antigen receptor (TCR) plays a central role in the recognition of antigen and subsequent T-cell activation. It is thought that a selective TCR repertoire may contribute to the immunopathogenesis of certain inflammatory rheumatic diseases. In this review recent progress in our understanding of TCR usage and their role in a variety of rheumatic diseases will be discussed. In addition, novel immunotherapeutic strategies based on a better understanding of the molecular mechanisms of antigen recognition will be reviewed.