Tracking the epidemiology of systemic lupus erythematosus is problematic because the diagnosis can be elusive. Systematic review of cases is also difficult because of the varying paths these patients take through the medical provider system. In general, 7 women are stricken with the disease for every man, with an 11:1 female-to-male ratio during the childbearing years. African-Americans are disproportionately afflicted, and evidence is at least suggesting a higher prevalence among other ethnic groups including Hispanics, Asians, and native Americans. Difficulties with defining the patient population, along with minimal education for physicians, may contribute to suboptimal treatment, especially in the critical early stages of disease.