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Objectives Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease requiring long-term treatment. Sustained medication is essential to prevent flares and organ damage, but poor adherence remains frequent. Our aim was to evaluate DMARD adherence in patients with SLE and identify factors associated with nonadherence.Methods A cross-sectional study included patients fulfilling the American College of Rheumatology classification criteria for SLE under treatment at our rheumatology department. Data were collected through structured interviews and review of clinical and dispensing records during routine or scheduled visits. Medication adherence was assessed using the Medication Adherence Tool (MAT) over the previous six months, validated in the Portuguese population; patients scoring below the sample median were classified as nonadherent. Dispensing records were used to calculate the Proportion of Days Covered (PDC) for DMARDs, with nonadherence defined as PDC <80%. Beliefs about medicines were evaluated with the Beliefs about Medicines Questionnaire – Specific, and anxiety and depression with the Hospital Anxiety and Depression Scale. Disease activity was measured using the SLEDAI-2K. Nonparametric tests and Cohen’s Kappa were performed.Results Of 81 eligible patients, 32 were included (remainder not contactable/not attend). Most were female (75%) with a median age of 40 years (IQR 35–54) and disease duration of 10 years (IQR 5–13). Median SLEDAI-2K at last visit was 0 (IQR 0–2). Hydroxychloroquine was used by 90.6%, other csDMARDs by 50% and bDMARDs by one; 65.6% were polymedicated. Median MAT score was 5.71 (IQR 5.43–5.96), classifying 40.6% as nonadherent. Median PDC was 83.3% (IQR 51.4–100), with 43.8% nonadherent. MAT and PDC showed moderate agreement (Cohen’s Kappa 0.424, p=0.016). Hydroxychloroquine adherence was lower in nonadherent patients (PDC 33.3% vs 94.4%, p=0.028). Recent lupus-related hospitalizations or emergency visits were associated with nonadherence (38.5% vs 0%, p=0.016).Abstract PO:10:255 Table 1Characteristics of disease-modifying antirheumatic drug (DMARD) adherent and nonadherent systemic lupus erythematosus (SLE) patientsConclusions 40.6% of SLE patients were nonadherent to DMARDs according to MAT, within the lower range of previous reports, associated with recent lupus-related hospitalizations or emergency visits. Limitations include small sample size, self-report and selection bias, and that pharmacy refill data reflect dispensation rather than intake. Larger studies and validation of SLE-specific adherence tools in Portugal are needed to identify determinants of nonadherence and improve outcomes.