Involvement of the musculoskeletal system is common if not universal in the clinical course of systemic lupus erythematosus (SLE). Joint involvement on the whole does not cause major erosive disease, however, recent developments in musculoskeletal imaging show clearly the presence of significant bony and soft tissue involvement. It might well explain the frequently observed discordance between the clinical signs and the articular symptoms assuming that fibromyalgia has been excluded. The clear demonstration of tendon involvement in SLE by MRI would merit considering tendonitis and tenosynovitis as candidates for inclusion in the diagnostic criteria.