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Objectives To assess the functional status and musculoskeletal manifestations of postpartum women with systemic lupus erythematosus (SLE) compared with healthy controls, and to evaluate the role of early involvement of physical and rehabilitation medicine specialists. A secondary objective was to analyse the relationship between disease activity and perceived exertion with functional recovery.Methods A prospective cohort study included 16 postpartum women with SLE and 20 controls followed from January 2022 to December 2024. A physiatrist assessed HAQ-DI, SF-36, muscle strength, sit-to-stand and 6-minute walk tests, Borg scale (6–20), and presence of arthritis, myalgia, fibromyalgia points, tendinitis, and enthesopathy. Disease activity was measured by SLEDAI-2K. Assessments were done at 2 weeks, 6 weeks, and 6 months postpartum.Rehabilitation included individualized low-to-moderate intensity exercises for core stability, lower-limb strength, posture correction, pain prevention, and home-based education.Results Mean age SLE 28.4 plus/minus 4.6 years; controls 27.9 plus/minus 3.8. Musculoskeletal symptoms were more frequent in SLE: fatigue 88 percent, back pain 75 percent, neck pain 69 percent, myalgia 81 percent, small-joint arthritis 44 percent, De Quervain’s tenosynovitis 31 percent, carpal tunnel 25 percent, fibromyalgia with 11 or more tender points 38 percent, Jaccoud’s arthropathy 13 percent.Borg score during the 6MWT was higher in SLE (14.8 plus/minus 2.3 vs 9.2 plus/minus 1.8) and correlated with HAQ-DI (r=0.72). Patients with SLEDAI greater than 6 reported greater exertion (16.2 plus/minus 1.9 vs 13.1 plus/minus 2.1). Handgrip strength was lower (18.2 plus/minus 6.4 vs 26.8 plus/minus 5.1 kg). Early physiatric involvement (2 weeks or less) led to better outcomes (SF-36 PF 72.5 plus/minus 12.3 vs 58.4 plus/minus 15.7).Conclusions Early multidisciplinary management, including a specialist in physical and rehabilitation medicine, is essential for timely recognition of musculoskeletal manifestations, which are more frequent in postpartum women with SLE.We observed that better functional outcomes were achieved when rehabilitation was provided through coordinated collaboration between rheumatologists and physical and rehabilitation medicine specialists under medical supervision, underscoring the importance of a structured medical approach.Individualized low-to-moderate rehabilitation adjusted to perceived exertion improves recovery. Early involvement of a physiatrist in postpartum SLE care is recommended.