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Objectives The aim of our study is to assess tunisian SLE patients out-of-pocket (OOP) expenditures on disease management and their impact.Methods A cross-sectional study with an anonymous online questionnaire form via the Facebook support group for tunisian SLE patients. The questionnaire included sections about patients characteristics, OOP expenditures during disease remission periods, psychosocial impact, and treatment adherence.Results Eighty-four patients participated in the study, predominantly women (98.8%), with 75% being under 40 years old. Among them, 42% were unemployed and 64% were financially dependent. Sixteen percent of participants earned less than the minimum wage. Most participants benefited from public health insurance (75%), with 66.7% having full coverage and 10% were uninsured.Participants had to travel to another city for specialist care in 57% of cases. Only 22.9% of participants did not pay consultation fees, with a median cost of 23.9 USD/clinic among those who did. Following each visit, only 12% did not pay for laboratory tests. Median OOP cost was 47.8 USD/clinic for blood and urine tests.Regular imaging was reported by 64%, most commonly ultrasound (67%), with a median annual cost of 204.9 USD. 88% reported OOP for medications, hydroxychloroquine being the most frequently self-purchased drug (76%). The median OOP cost was 34.15 USD/clinic for drugs. All patients paid for sunscreens, with a median of 34.15 USD per trimester. For annual ophthalmologic monitoring, 73% reported OOP, with a median cost of 68.3 USD/year.Non-medical costs included transportation to clinics (median 10 USD/clinic), dietary modifications (170.7 USD/year), sun-protective clothing (68.3 USD/year), and camouflage make-up (49.5 USD/year).74% stated that their monthly income was insufficient to cover their medical costs, and 42% had to borrow money or sell belongings to cover them.The financial burden of SLE led to psychological stress in 81% of cases. Because of these financial constraints, 49% missed clinic appointments, 34.5% skipped laboratory or imaging tests, 19% missed medication doses, and 35% did not purchase sunscreen.Conclusions Even considering the selection bias, tunisian patients seem to be a financially vulnerable population. These financial burdens seem to cause lack of adherence and psychological stress that can alter disease outcome.