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Objectives Pulmonary involvement is a frequent and significant feature of Systemic Lupus Erythematosus (SLE), although its clinical spectrum and outcomes remain poorly defined. This study aims to characterize the clinical features of pulmonary involvement in a multicentre Portuguese SLE cohort.Methods A multicentric, retrospective study was conducted across five Portuguese Rheumatology Departments, including adult SLE patients with at least one pulmonary manifestation (PM) attributable to SLE. Demographic and clinical data were collected, and a descriptive analysis was performed.Results A total of 51 SLE patients fulfilling the 2019 EULAR/ACR classification criteria with PMs were included. The majority were female (74.5%), with a mean age at SLE diagnosis of 37.0 ± 17.5 years and a mean age at first PM of 42.9 ± 17.6 years. The most common extra-pulmonary features were arthritis (74.5%), leukopenia/lymphopenia (52.9%) and acute cutaneous lupus (47.1%). Serositis was observed in 58.8% of patients. Most patients were non-smokers (71.4%), and chronic pulmonary diseases were infrequent (3.9–5.9%).PM occurred at the time of SLE diagnosis in 52.9% of patients, and after a mean interval of 12.9 ± 9.9 years in the remaining cases. The most frequent PMs were pleural involvement (56.9%) and interstitial lung disease (ILD) (21.6%), followed by pulmonary embolism (15.7%), pulmonary arterial hypertension (11.8%), and acute lupus pneumonitis (5.9%). Only one patient had shrinking lung syndrome, and 15.7% of patients presented more than one PM. At the time of PM, 44 of 46 patients (95.7) were symptomatic. The most common symptoms were pleuritic pain (54.5%), dyspnea (43.2%), fever (17.8%) and cough (15.9%). Median SLEDAI-2K and SLE-DAS reflected moderate disease activity. During the pulmonary episode, 40.8% of patients were hospitalized and 8.3% required oxygen therapy. There were five deaths overall, three due to infection, one related to SLE-associated PM, and one from cardiovascular disease.Abstract PO:09:225 Table 1Demographic, clinical, and pulmonary characteristics of patients with systemic lupus erythematosus and pulmonary involvement (n=51)Conclusions PMs in this SLE cohort represented significant morbidity. Although mortality directly attributable to PM was low, the clinical burden was substantial, with 95.7% of patients symptomatic and 40.8% hospitalized. Pleural disease was the most frequent manifestation, while ILD and pulmonary embolism highlight the need for a high index of suspicion to mitigate these complications.