By WILLIAM D. ROBINSON
HIS DISCUSSION will reflect certain concepts concerning the nature T of systemic lupus erythematosus and the iduence of agents used in its management. First, the diagnosis must be based on adequate clinical and laboratory evidence of multiple system involvement, rather than any single manifestation or test. Secondly, the disease is a chronic one with fluctuations in the level of activity. In the not too distant past, it was usually recognized only in its acute, fulminating and often fatal form. With the development of more precise methods of diagnosis it has become apparent that such fulminating stages are nearly always episodes in a long-term illness with subacute or chronic low grade manifestations, and that systemic lupus erythematosus often is characterized only by such subacute or chronic activity. In the third place, the agents used in management of the disease are essentially suppressive. The dramatic effect of adrenal corticosteroids in essence depends on their ability to convert the acute fulminating form of the disease to a subacute or chronic level of activity. ~ From the Department of Z n t d Medicins, and Rackham Arthritfs Re.wmch Unit a grant from the Horace H . Rackham School of Graduute Studies) Tha