NIAMS further suggested, in the interest of coherence, focusing the workshop on two autoimmune diseases with characteristics that would make them, as a set, case studies representative of other rheumatic diseases and chronic diseases in general. Systemic lupus erythematosus (SLE) is an intermittent, relapsing illness with effects that involve multiple organ systems. The main organs affected are joints, skin, kidney, brain, heart, and lungs. There is a relatively high probability of death at a young age, but the illness itself has the characteristics of an intermittent illness with peaks and valleys of severity and remission. In contrast, rheumatoid arthritis (RA) is an ailment that can range from very minor symptoms over a long time to an extremely crippling disorder with physical deformity of the joints—that is, it is a model of chronic, progressive, and severely disabling disease. Although persons with RA also have a reduced life expectancy, RA does not generally pose the same threat to life as SLE does. A considerable amount of information is already available about these two diseases; they represent quite different clinical, epidemiological, and social problems; and both diseases are significant contributors to morbidity and health care costs in the United States.
In the early decades of this century the purchase and delivery of health care in the United States resembled typical transactions in other fields: patients directly purchased all or nearly all services from a general practitioner in solo practice. Rapidly accelerating growth in new medical knowledge and technology improved medical care, but increased both the number of specialists and the costs of treatment. Health insurance, most often subsidized by employers, assumed an increasingly important role after World War II. It