Purpose of Review <p>The increase in available treatments has resulted in a significant improvement in the management of autoimmune rheumatic diseases (ARDs). Despite improvements in disease-specific outcomes, the diseases and their treatments can predispose to long-term risks of metabolic dysfunction including higher rates of sarcopenia and metabolic obesity. Higher rates of cardiovascular, metabolic, and other complications have been recognized over time, though mechanistic pathways that link ARDs, metabolic obesity, muscle loss, and adverse long-term outcomes remain inadequately characterized. In this review, we aim to overview recent research evaluating interplay between inflammation, immunomodulatory treatments, adiposity, and sarcopenia as well as the impact on clinical outcomes.</p> Recent findings <p>Recent studies continue to explore the relationship between ARDs, body composition, and cardiometabolic outcomes. Recent work has also highlighted clinical associations with adipo(cyto)kines, circulating signaling proteins that play a role in energy homeostasis. However, much work remains to characterize the causal role of these proteins in the context of ARDs. While some studies have shown a potential metabolic benefit to pharmacologic therapies for ARD, more work is needed, particularly in less common ARDs.</p> Summary <p>Inflammation in the context of ARDs is linked to metabolic changes including metabolic obesity and sarcopenia. While treatment of the underlying conditions may have metabolic benefits, some treatments increase metabolic risk. Further study is needed to better inform management, particularly with advent of effective therapies for weight loss.</p>