Although survival rates improved markedly during the past 5 decades, patients with systemic lupus erythematosus (SLE) still die at a rate 3 to 4 times that of the general population.1–,4 The Centers for Disease Control and Prevention5 recently reported that between 1979 and 1998 the number of deaths due to SLE increased by 60%. In addition to experience in caring for patients with SLE, knowledge of the epidemiology, pathophysiology, and morbidity and mortality factors may contribute to improvements in the management of these patients. In 2 separate studies Ward,6,7 found that hospitals that treated large numbers of patients with SLE had 68% less mortality than did hospitals with less experience with such patients. The risk of in-hospital mortality was even lower, 95% less, for patients cared for at facilities that treated 100 or...

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