Currently, the main goal in rheumatic research is to achieve remission, even in highly active stages of the disease. However, there is a lack of understanding of how to manage patients when some rheumatic diseases such as vasculitis, connective tissue disease, or rheumatoid arthritis develop fulminant, progressive, and complicated courses. There is a clear role for palliative care to enhance patients' quality of life, but hardly any data exist regarding the prevalence and management of symptoms, and the special needs of these patients and their relatives. Rheumatologists, and palliative and primary care physicians should become more aware of this patient group so as to offer them the care they need. Further research is necessary in this field.