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Objectives To characterize patterns and variability in the management of systemic lupus erythematosus (SLE), including the implementation of a treat to target (T2T) strategy in Spain, and to identify relevant multi-level contextual factors, barriers and facilitators.Methods A qualitative study was conducted based on a contextual analysis (CA) following the Basel Approach for coNtextual ANAlysis (BANANA) framework. This approach included data collection of contextual factors extracted from the literature and other secondary sources, complemented by primary data collection on factors not captured in the review through five structured focus groups with rheumatologists.Results We observed significant variability in clinical practice regarding SLE management across regions and hospitals. Key barriers were identified at multiple levels: patient/disease, healthcare professional, organisational, and evidence-base documents. At the patient/disease level, major barriers included the complexity of SLE, diagnostic delays, and insufficient knowledge or education ( table 1). At the healthcare professional level, barriers encompassed limited knowledge of the T2T strategy in SLE, variable clinical expertise, resistance to change, and the absence of standardised use of validated assessment tools for disease activity, organ damage and treatment targets (Lupus Low Disease Activity State (LLDAS) and remission) (table 1). Organisational barriers include the lack of structured multidisciplinary care, increasing administrative burden during clinical encounters, and suboptimal integration of patient-reported outcomes into electronic medical records (table 1). Implementation of T2T principles and SLE clinical guidelines was infrequent by perceived complexity, limited evidence strength, time constraints, insufficient digital infrastructure, and limited training (table 2).Abstract PO:05:149 Table 1–2Conclusions This CA highlights critical barriers to optimal SLE management with effective implementation of the T2T strategy in Spain. Our findings underscore the need for tailored, context-specific implementation strategies addressing knowledge gaps, organisational inefficiencies, digital integration, and patient empowerment.Acknowledge Thank you for the outstanding work and unwavering commitment of the T2T Lupus Spain working group. Your expertise, collaboration, and dedication have been instrumental in driving this initiative forward and delivering meaningful impact.