Indicators of disease activity, prognosis, and treatment of systemic lupus erythematosus.

Several instruments have been developed to assess disease activity in systemic lupus erythematosus. Any study of a new laboratory measure, any therapeutic trial, and any study of outcome and prognosis should include one of these validated measures of disease activity. The treatment of lupus is far from ideal. A controlled trial of plasmapheresis showed no benefit over standard regimens in lupus nephritis. A long course of pulse cyclophosphamide was shown to be better than pulse methylprednisolone or a short course of intravenous pulse cyclophosphamide. Despite the lack of ideal therapy, the prognosis of lupus, including 15-year survival rates, has improved over the past 4 decades. Specific organ damage continues to be an issue. Infection and vascular disease have emerged as important factors. With improved survival, other outcome measures, including specific organ function and health status, must be considered.