Systemic lupus erythematosus--changing disease patterns in the disease course. Dutch experience with 110 patients studied prospectively.

The aim of this study was to investigate which patients with systemic lupus erythematosus (SLE) are prone to develop more than one exacerbation, and to establish the variability in the clinical symptoms during exacerbations as compared with the initial symptoms of the disease. At disease origin, photosensitivity, pleuritis and Raynaud's phenomenon were slightly increased in the patients with a stable disease, while pericarditis was rarely seen in patients with a remitting disease course. In this prospective study it was clearly shown that during the disease course, depending on the exacerbation frequency, an increasing number of organs were involved. Striking features were the increase in haematological abnormalities in the third exacerbation, and the fact that psychosis and seizures did not recur in the second exacerbation when they were diagnosed in the preceding period. We also showed that symptoms seen in an exacerbation may be quite different from those seen in a previous exacerbation.