To send SMS with Twilio using Node.js, you first need to create a Twilio account and install Node.js with npm. Then, you need to set up your Twilio account credentials as environment variables or directly in your code. Next, you create a new Twilio REST client instance and use its `messages.create` method to send an SMS from your specified sender number to the recipient's number. You can do this by installing the Node.js Twilio library with npm, creating a file called `sms.js`, and writing the required code to create a Twilio client instance and send an SMS. Finally, you need to save and run the `sms.js` file using the command `node sms.js`.