Rheumatic immune-mediated diseases comprise a group of chronic inflammatory conditions affecting the bones, joints, and surrounding soft tissues. In recent years, mounting evidence suggests that histone acetylation and immune system dysregulation play pivotal roles in the pathogenesis and progression of these diseases. Sirt1, a nicotinamide adenine dinucleotide (NAD+)-dependent class Ⅲ histone deacetylase, modulates the activity of transcription factors and inflammatory molecules through deacetylation modifications, thereby regulating the functionality and activity of immune cells. Consequently, Sirt1 plays a crucial role in the modulation of the immune system in rheumatic immune-mediated diseases. This review summarizes the recent research progress on Sirt1 in rheumatic immune-mediated diseases