Autoantibodies and immune complexes play a pivotal role in the pathogenesis of a wide range of rheumatic diseases. Therapeutic apheresis removes these pathogenic molecules from plasma. Several apheresis modalities are used in rheumatology. However, their role as treatment option has evolved with the introduction of novel immunosuppressive and anti-inflammatory agents (e.g., Rituximab, Infliximab). This chapter will demonstrate different apheresis protocols in major rheumatic diseases (e.g., systemic lupus erythematosus, ANCA-associated vasculitis, catastrophic antiphospholipid syndrome) and will discuss their effectiveness in association with current pharmacological therapies.