Survival Patterns in Systemic Lupus Erythematosus

To the Editor.— Daniel Wallace, MD, and co-workers.should be commended for their article on "Systemic Lupus Erythematosus—Survival Patterns" (1981;245:934). Their follow-up data will aid in projecting prognosis in individual patients with systemic lupus erythematosus (SLE) as well as organizing prospective controlled trials of therapy. I was interested in their finding that males with SLE have a significantly decreased survival compared with females. Several years ago I was impressed that there were relatively equal numbers of males and females with SLE entering our end-stage renal disease programs. This prompted me to examine prognosis with regard to sex in 75 patients with SLE and nephritis. Of the 17 males, seven experienced renal failure (defined as a serum creatinine level greater than 6 mg/dL, dialysis, or renal transplant), and four died. Four of 58 female patients with lupus nephritis experienced renal failure, and five died. Thus, 65% of the males experienced renal failure,