A hallmark of the rheumatic diseases, including systemic lupus erythematosis, spondyloarthritis, and rheumatoid arthritis, has been sustained inflammation, which typically targets the joint and may lead to joint destruction. Inflammation also plays a role in atherosclerotic cardiovascular disease, which is highly prevalent in patients with rheumatic diseases. Total joint arthroplasty, considered an intermediate cardiac risk procedure by the American College of Cardiology, maintains an important role in the management of rheumatic disease patients who progress to end-stage joints. The purpose of this article is to discuss the role of inflammation in cardiovascular disease, the prevalence of cardiovascular disease in patients with systemic rheumatic diseases, and the role of cardiovascular risk assessment when these patients undergo total joint arthroplasty.