Since the first systemic lupus erythematosus (SLE) guidelines published by the American College of Rheumatology in 1999, accumulating data from observational and randomized-controlled studies, including the advent of biological agents, have stimulated the production of recommendations by various committees and task forces. Still, several areas relating to the diagnosis, treatment, and monitoring of SLE remain uncertain due to limited or inconclusive evidence, therefore emphasizing the role of expert consensus in reaching balanced and informative statements. This review outlines the most recent SLE recommendations highlighting key differences and important challenges that will also need to be considered in future updates.