Survival in Systemic Lupus Erythematosus

To the Editor.— We commend Urman and Rothfield (238:2272-2276, 1977) for their analysis of the large groups of cases of systemic lupus erythematosus (SLE) followed at Bellevue Hospital and Clinic and the University of Connecticut Hospital and Clinics. Although it adds to a growing literature that supports the contention that the survival of patients with lupus is improving, it does not clarify the reasons for this improved survival. There were many improvements in diagnosis and therapy during the years that this study covered. These included easier screening for lupus with the routine use of the antinuclear antibody, multiple new antibiotics, widespread use of peritoneal dialysis and hemodialysis, and other general supportive measures. The effect of the diagnostic changes was to widen the pool of patients with SLE by including patients who were less ill and had better prognoses. In addition, the new therapeutic measures improved the chances of the most