Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with increased risk of atherosclerosis. Despite the relative youth of lupus patients, they have risk for the development of premature cardiovascular atherosclerotic diseases. Objective: This work aimed to study the detection of atherosclerosis and the cardiovascular risk in SLE patients by nail fold capillaroscopy and the intima media thickness of the carotid artery. Patients and methods: This was a cross sectional study included 60 SLE patients. Patients were collected from the Outpatient Clinic and Inpatient of Internal Medicine and Rheumatology Departments within 6 months. Results: 22 patients (36.7%) had atherosclerosis, with higher SLE disease activity index (SLEDAI) score (p 0.002). 45.5 % of them had severe disease activity and 54.5% had moderate disease activity. Atherosclerotic patients had statistically significant lower capillary density (P 0.001), higher capillary length (P 0.008), capillary width (P < 0.001) and arterial limb diameter (P< 0.001) with higher prevalence of tortuous (P= 0.022), meandering (p=0.014) and disorganized capillaries (P= 0.008). There was statistically significant positive correlation between Intima media thickness (IMT) and disease duration, SLEDAI score, capillary width and arterial limb diameter, while there was statistically significant negative correlation with capillary density. The Arterial limb diameter had highest diagnostic performance in diagnosing atherosclerosis. Conclusion: Atherosclerosis is common in SLE & is associated with higher diseases activity. By capillaroscopy, lower density, longer, wider and disorganized capillaries and tortuous & meandering capillaries were associated with the presence of atherosclerosis.