Background: Self-efficacy for managing chronic conditions assesses the confidence an individual has on her/his ability of successfully performing specific tasks related to a chronic condition in several different situations. It is considered a modifiable behavior in educational interventions in SLE patients. The aim of this study was to evaluate the association between self-efficacy and damage accrual in SLE patients. Methods: We evaluated SLE patients from the Almenara Lupus Cohort. Self-efficacy was ascertained with six instruments of the Patient-Reported Outcomes Measurement Information System® (PROMIS®) Self-efficacy for Managing Chronic Conditions. For PROMIS instruments, a score of 50 is the average for a clinical population (people with a chronic condition), the higher score, the greater self-efficacy. Damage was assessed with the SLICC/ACR damage index (SDI). Generalized estimating equations were performed, using as the outcome any increase in the SDI and the self-efficacy instrument in the previous visit; multivariable models were adjusted for possible confounders measured at the same visit as the self-efficacy instrument. OR was reported per 5 units increase per self-efficacy instrument component. Results: A total of 209 patients (563 visits) were included. At baseline, mean general self-efficacy was 47.2 (10.4), self-efficacy for managing emotions was 44.6 (8.0), for managing symptoms was 47.7 (8.2), for managing daily activities was 45.5 (7.5) for managing social interactions was 42.9 (7.9) and for managing medications and treatment was 43.9 (7.0). During the follow-up visits, 41 (19.6%) patients accrued damage once and 2 patients (1.0%) accrued damage twice. In the multivariable models, a better self-efficacy for managing symptoms and daily activities was predictive of less damage accrual (table 1). Conclusions: A better self-efficacy mainly in managing symptoms and daily activities domains is predictive of a lower risk of damage accrual, even after adjustment for possible confounders. Strategies to improve self-efficacy in SLE patients should be encouraged to improve patients’ outcomes.