Systemic lupus erythematosus (SLE) is a multisystem autoimmune connective tissue disorder with various clinical presentations. It is prevalent among young women with a peak age of onset between the late teens and early 40s and a female to male ratio of 9:1. It is more common in certain ethnic groups, such as people with African or Asian ancestry. One study estimated the prevalence of lupus as 27.7/100 000 and as high as 206/100 000 in Afro-Caribbean women.1 SLE is a chronic illness that may be life threatening when major organs are affected but more commonly results in chronic debilitating ill health. No single cause for SLE has been identified, though factors such as sunlight and drugs may precipitate the condition, and there is a complex genetic basis. Autoantibodies may be present for many years before the clinical onset of the disease, and there may be increasing numbers of antibodies just before symptoms develop, pointing to a multi-factorial pathogenesis.2 I used PubMed to identify references, supplemented by review articles and lectures from the American College of Rheumatology annual conference in 2005. Search terms included systemic lupus erythematosus, antiphospholipid syndrome, lupus nephritis, central nervous system disease in lupus, and fatigue. Articles were selected according to their impact on clinical practice. It is not possible to give a comprehensive guide to the management of all the possible complications of lupus so I have focused on areas where there is a consensus on management or where there have been major new developments. The widely recognised presentation of a young woman with inflammatory arthritis and a butterfly facial rash is uncommon. Non-specific symptoms of fatigue, malaise, oral ulcers, arthralgia, photosensitive skin rashes, lymphadenopathy, pleuritic chest pains, headache, paraesthesiae, symptoms of dry eyes and mouth, Raynaud's phenomenon, and mild hair loss are more likely …