Severe major organ involvement in systemic lupus erythematosus. Diagnosis and management.

Deterioration in the function of major organs in patients with systemic lupus erythematosus may be due to causes directly related to the disease itself or to non-lupus related causes. In patients with rapidly progressive immune-mediated disease, therapy may be initiated with pulse glucocorticoids alone or in combination with pulse cyclophosphamide. For selected patients with aggressive life-threatening disease or patients refractory to treatment, experimental therapies such as plasmapheresis or intravenous immunoglobulin may be used as adjuncts in their management.