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Systemic Lupus Erythematosus

A. S. Townes, MD
JAMA. 1977;237(4):387. doi:10.1001/jama.1977.03270310073015.
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This small, readable volume provides a clinical review of systemic lupus erythematosus (SLE), but it is primarily a report of the author's experience with 142 patients with this disease seen at the Massachusetts General Hospital between 1932 and 1966 and a statement of her opinions about the disease and its management based on that experience. This group of patients is remarkable because of the length of follow-up and the observations recorded in many patients with major organ involvement without corticosteroid treatment.

The author's principal message is clear: that the course of SLE is highly variable and unpredictable, with a favorable outlook for survival for ten years or more in the majority of cases; that remissions occur and may be prolonged without corticosteroid therapy; and that rigorous proof is lacking of the efficacy of toxic drugs, including corticosteroids, in extending survival. The "conservative" program of treatment that the author advocates, using


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