Determinants of patient survival in systemic lupus erythematosus--focusing on lupus nephritis.

INTRODUCTION Systemic lupus erythematosus is more prevalent among Asians, African Americans, and Hispanics than in Caucasians. Progress in its management over the past few decades has resulted in improved patient survival, although a considerable proportion of patients are still afflicted with long-term illnesses such as chronic renal failure secondary to lupus nephritis. METHODS AND RESULTS This is a review of the factors that affect the survival of patients with systemic lupus erythematosus, including discussion of the measures that can further improve the clinical outcomes and prevent long-term complications. Recent advances in the treatment of severe lupus nephritis are emphasized, especially with regard to the minimization of treatment-related adverse events. CONCLUSIONS While the prognosis of patients with severe lupus manifestations continues to improve, prevention of relapse remains a clinical challenge. Concomitant attention to health economics and sociopolitical issues is required to ensure that all patients can benefit from scientific progress in the understanding and treatment of severe lupus erythematosus.