[Aggressive therapy of highly active systemic lupus erythematosus]

Life-threatening exacerbations of systemic lupus erythematosus can endanger the function of vital organ systems and require massive immunosuppressive treatment after the diagnostic delineation of the situation. In addition to high dosages of corticosteroids, the introduction of high dose intravenous cyclophosphamide has improved the prognosis of organ function in SLE in the past years. The concept of plasmapheresis has been left in most centers, although in vitally dangerous situations the application of selective immunoglobulin removal techniques (immunoabsorption) has been reported to be beneficial. The long-term treatment following the acute exacerbations has to consider the side effects of all immunosuppressive drugs like infections and neoplasia, although the danger of another autoaggressive attack of the patient's own immune system has to be kept in mind.