Schematic outline for genomics in rheumatic diseases. Patients with rheumatic diseases exhibited striking heterogeneity, based on clinical, biological and molecular criteria. Categorization of patients is expected to be of the utmost importance for decision making in clinical practice. Application of high-throughput screening technologies such as genomics allows us to characterize patients based on their molecular profile. The procedure starts with collecting different types of material such as serum, peripheral blood (PB) cells, RNA from blood (using, for example, Paxgene tubes), tissue biopsies and isolated mesenchymal cells from the same patients. Gene expression profiles of this material can be determined using genomics technology. When associated with clinical readouts, we could select the clinically useful molecular markers and apply these in routine clinical practice. In addition, these data may help to elucidate the distinct pathological mechanisms that are at play, potentially explaining the inter-patient variation in clinical presentation, disease progression and treatment response. Ultimately, knowledge of the different pathogenic mechanisms may help us to identify new drug targets for selected patient subgroups.