Increased longevity of patients with systemic lupus erythematosus (SLE) leads to 
chronic organ damage accrual, which reduces the possibility of further survival 
improvement in patients with the disease. Observations from lupus centres 
worldwide revealed that the prevalence of damage occurring in the cardiovascular 
system in patients with SLE has increased over the past four decades. The 
results of a meta-analysis involving over 70 observational studies demonstrated 
that lupus-related organ damage involving the neuropsychiatric and renal systems 
also remains a major factor that limits survival improvement in patients with 
this disease. While efforts to halt acute lupus-related injury are continuing, 
through early diagnosis and effective use of immunosuppressive agents, a 
concomitant strategy to improve survival of patients with SLE would be early 
detection and timely treatment of lupus-related organ damage with meticulous 
monitoring. This Review discusses the pattern and trend of organ damage in 
patients with SLE worldwide, the potential serological and genetic mechanisms of 
organ damage, and the advances in research on potential tools for early 
detection of lupus-related organ damage, such as functional brain imaging 
techniques, measurement of endothelial function, identification of biomarkers 
from body fluids, and development of risk calculation models.