Systemic lupus erythematosus is a complex disease characterized by a loss of immune tolerance leading to autoantibody production, immune complex deposition in target organs, and resultant tissue damage. There are currently only three medications approved for the treatment of lupus; hydroxychloroquine, aspirin, and prednisone. This limited spectrum of medications is contrasted by the dozen clinical trials in lupus underway or planned for the next 2 years. These new therapeutic agents hold promise for being more effective with fewer side effects than the current available agents. Increased awareness of co-morbid diseases in lupus is also leading to new approaches for the prevention of "disease damage" in lupus.