The severity of lupus is influenced by both disease activity and the possibility of organ damage over time. Organ damage in people with lupus is thought to arise slowly over time due to an interaction of disease processes, possible co-existing conditions, and drug treatments. Levels of autoantibodies circulating in the blood are a primary indicator of lupus disease activity and can change over time, but these dynamics around the time of lupus diagnosis have not been well studied. The results of this study reveal differences in autoantibody profiles over time in people with lupus, with important ethnicity-related differences, and their relationship to lupus-mediated organ damage over time. The potential relationship between organ damage and steroid use in people with lupus is discussed.