The prognosis of systemic lupus erythematosus has improved over the past four decades. We now have data for 15-year survival, which has also improved. Several factors may be associated with improved survival, including earlier diagnosis, better treatment, and improved medical therapy. Specific organ damage continues to be an issue, primarily with regard to kidney disease and to neurocognitive impairment and lung involvement. Infection and vascular disease emerge as important factors. With improved survival, other outcome measures, including specific organ function and health status, need to be considered.