Deterioration in the function of major organs in patients with systemic lupus erythematosus may be due to causes directly related to the disease itself or to non-lupus related causes. In patients with rapidly progressive immune-mediated disease, therapy may be initiated with pulse glucocorticoids alone or in combination with pulse cyclophosphamide. For selected patients with aggressive life-threatening disease or patients refractory to treatment, experimental therapies such as plasmapheresis or intravenous immunoglobulin may be used as adjuncts in their management.