Systemic lupus erythematosus presents significant challenges in diagnosis and management due to its variable clinical manifestations, overlapping symptoms with other diseases and unpredictable disease course. Delayed or missed diagnosis often results from non-specific initial symptoms like fatigue, joint pain and skin rashes, leading to increased disease activity, organ damage and patient frustration. On the other hand, all patients with positive antinuclear antibodies and joint pain should not be diagnosed as having systemic lupus erythematosus because there is a risk of overdiagnosing the disease. Underappreciation of organ involvement, such as lupus nephritis, neuropsychiatric lupus or cardiovascular complications, further contributes to poor outcomes. Inconsistent monitoring of disease activity and overtreatment or undertreatment exacerbate disease progression and medication-related side effects. Additionally, the psychological impact of systemic lupus erythematosus, including depression and anxiety, is often overlooked. Patients are also at increased risk of certain malignancies, complicating diagnosis and management. A multidisciplinary, patient-centred approach emphasizing early diagnosis, consistent monitoring and personalised treatment strategies is essential to improve outcomes and quality of life.