Background COVID19 pandemic likely has had significant influence on the presentation, management and outcome of Systemic Lupus Erythematosus (SLE). A single-centre experience of managing SLE during the 3rd wave of COVID19 pandemic in Sri Lanka is presented.

Methods New and follow up patients with SLE seen at Peradeniya University Teaching Hospital from the 1st of July to the 31st of August 2021 were audited. Those with moderate to severe disease (assessed by British Isles Lupus Assessment Groups 2004/BILAG score¹) requiring intensification of immunosuppression, were identified. Possible effects of the pandemic on the clinical presentation, and treatment outcome were assessed.

Results Of 45 patients with SLE seen during this period, eleven had moderate to severe flares (female:male 10:1). Four were new diagnoses during the study period. Of the seven follow-up patients, six had well-controlled disease over the preceding 24 months, while one had intermittent flares.

9 out of 11 patients were BILAG-A in at least one domain and two were BILAG-B. All needed aggressive immunosuppression. Remission was induced in ten patients while one succumbed to severe disease and sepsis.

In 72.7% of patients (n=8), effects of COVID19 were evident. These were possible causal association (n=1), disease flare concomitant with COVID19 infection (n=2), COVID19 complicating immunosuppression (n=1) and delayed presentation leading to requirement of aggressive immunosuppression (n=4).

Conclusions Diagnosing and managing SLE is challenging due to variable clinical presentation, multi-system involvement and complex treatment decisions.² The on-going pandemic has increased these challenges several-fold. COVID19 probably has a causative relationship with autoimmune disease.³ Delayed presentation can cause unfavourable outcomes during the pandemic.