Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease associated with progressive joint damage and important extra-articular complications, including osteoporosis, reduced Bone Mineral Density (BMD), fragility fractures, metabolic syndrome, insulin resistance, dyslipidemia, sarcopenia and cardiovascular disease. Chronic inflammation, reduced physical activity, altered body composition, nutritional deficiencies and long-term pharmacological therapy contribute to these complications. Glucocorticoids are particularly important because prolonged exposure may reduce bone formation and adversely affect glucose and lipid metabolism, although suppression of inflammation may partially counterbalance their skeletal effects. Disease-Modifying Antirheumatic Drugs (DMARDs), particularly biologic and targeted synthetic therapies, generally improve inflammatory control and may help preserve BMD but recent evidence suggests that bone loss can persist despite effective disease control. Metabolic syndrome is also common in RA and contributes substantially to cardiovascular risk. The relationship between RA and lipid abnormalities is complex because active inflammation may suppress circulating lipid concentrations despite increased cardiovascular risk. This narrative review summarizes current evidence regarding BMD changes, osteoporosis, glucocorticoid exposure, DMARD therapy, vitamin D status, metabolic abnormalities, sarcopenia and cardiovascular risk in patients receiving long-term treatment for RA. An integrated approach combining disease control, fracture-risk assessment, BMD monitoring, glucocorticoid minimization, metabolic screening, lifestyle modification and cardiovascular risk management is essential for comprehensive long-term care.