Common complications of systemic lupus erythematosus include dermatitis, nephritis, and arthritis. Prognosis is generally poor, and the 10-year mortality rate of patients with systemic lupus erythematosus is approximately 40%. The disease’s course can be divided into 4 subcategories: developmental phase, preclinical phase, clinical phase, and comorbid complication phase.

Systemic lupus erythematosus (SLE) is an autoimmune disease. Several flare-ups may happen in the course of the disease. SLE usually develops in the second and third decades of life, although it can present at any age. It usually starts with mild symptoms such as fatigue, fever, and skin rashes. Without treatment, the patient will develop symptoms of end organ damage, which will eventually lead to death in most patients.

The disease course can be divided into 4 subcategories based on the course of the disease:^[1][2][3]

• Genetic mutations
• UV radiation exposure
• Smoking

• Mostly associated with auto-immune antibody production
• Autoantibodies common to other systemic autoimmune diseases
• Proceeds with a more disease-specific clinically overt autoimmune phase

• The phase due to damages of the autoantibodies to the body tissues (mostly related to disease itself)
• Inflammation
• Involvement of first organs
• Flares
• Involvement of additional organs
• Early damages (e.g. alopecia, fixed erythema, cognitive dysfunction, valvular heart disease, avascular necrosis, tendon rupture, Jaccoud’s arthropathy, and osteoporosis)

The phase of damages due to complications of longstanding disease, immunosuppressive therapy, and end organ damage (irreversible damages and complications)

• Infections
• Atherosclerosis
• Malignancies

• Stress (emotional, etc.)
• Sunlight
• Ultraviolet light
• Infection
• Injuries
• Surgery
• Pregnancy
• Abrupt discontinuation of medications
• Treatment noncompliance
• Medications
• Immunizations
• Lupus nephritis
• Presence of neurologic complications
• Presence of vasculitis
• Elevated anti-dsDNA
• Low C3 level

Complications that can develop as a result of prolonged activation of systemic lupus erythematosus or the SLE therapy are:^{[6][7][8][9][10][11][12][13][14][15][16]}

(Up arrows represent higher frequencies and down arrows represent lower frequencies)

The prognosis of systemic lupus erythematosus ranges from a benign illness to an extremely rapid progressive disease that can lead to a fulminant organ failure and death. Without treatment, systemic lupus eryhtematosus will result in a very high mortality rate, with a report of higher than a 60% mortality rate during the mid-20th century. The presence of nephritis is associated with a particularly poor prognosis among patients with SLE; SLE is associated with a 10-year mortality of more than 50% among patients with nephritis. The increase in survival rate of patients and better prognosis may be due to increased disease recognition with more sensitive diagnostic tests, earlier diagnosis or treatment, the inclusion of milder cases, increasingly judicious therapy, and prompt treatment of complications. Although improvements in SLE diagnosis have led to better prognosis, the mortality rate among SLE patients is still 5 times higher than the normal population.^{[17][18][19][20]}

• Presence of nephritis (especially diffuse proliferative glomerulonephritis)
• Hypertension
• Male sex
• Young age
• Older age at presentation
• Low socioeconomic status
• Black race: Higher rate of nephritis
• Presence of antiphospholipid antibodies
• High overall disease activity

• Lupus nephritis
• Progression to end-stage renal disease
• Increased disease severity
• Damage or poor survival

• Features of the antiphospholipid syndrome (APS)
• CNS involvement
• Severe lupus nephritis
• Increase in mortality rate

• Less photosensitivity
• More serositis
• Older age at diagnosis
• Higher 1 year mortality compared to women

• Lower incidence of:
  • Malar rash
  • Photosensitivity
  • Purpura
  • Alopecia
  • Raynaud’s phenomenon
  • Nephritis
  • Central nervous system involvement
• Greater prevalence of:
  • Serositis
  • Pulmonary involvement
  • Sicca syndrome
  • Musculoskeletal manifestations