Treatment of systemic lupus erythematosus: which options do we have for therapy regimens?

The prognosis of systemic lupus erythematosus has improved markedly. This has been due to various factors: improved serological testing leading to better diagnosis, better understanding of secondary complications, and the possibility of treating these. How much has improved treatment of the primary disease process contributed to the improvement in prognosis? We have evaluated the clinical outcome of 56 patients with lupus nephritis proven by biopsy, followed at out hospital over the past 16 years. During this period various therapies were used during active periods of the disease, based on literature data or participation in trials. Prognostic risk factors for the development of end stage renal disease (ESRD) appeared to be: WHO-class IV histopathology of the renal biopsies, male sex and raised serum creatinine. Development of ESRD at 5 years was 13% and at 10 years was 30%. Overall survival was 95%. Based on data from well controlled trials performed at the National Institute of Health (US) and our observations the need for well conducted long-term prospective randomized trials is stressed again.