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Despite substantial cardiovascular morbidity and mortality, patients with rheumatologic disease remain underrepresented in HF research, and the mechanisms linking inflammation to HFpEF remain underdescribed in this population. This review examines the intersection of systemic rheumatologic disease and HFpEF, focusing on shared pathophysiology, diagnostic challenges, and therapeutic opportunities. Patients with rheumatologic diseases, including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, and systemic sclerosis, exhibit a markedly increased risk of HFpEF. Chronic inflammation, microvascular dysfunction, and myocardial fibrosis emerge as key drivers. These conditions complicate diagnosis because of atypical symptoms and overlapping comorbidities. Although existing HFpEF therapies primarily target hemodynamic and metabolic contributors, they seldom address immune\u2010mediated mechanisms. Anti\u2010inflammatory strategies have shown cardiovascular benefit in selected populations; yet their role in HFpEF among rheumatologic subgroups remains underexplored. Exclusion of patients with rheumatologic disease or immunosuppressive therapy from HFpEF trials further limits generalizability. In conclusion, HFpEF associated with rheumatologic disease represents a distinct, underrecognized inflammatory phenotype. 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