Preface

This book provides guidance on the assessment and management of patients with systemic lupus erythematosus. The book is focused on recent advances in the epidemiology, pathophysiology, pathogenesis, and management of the disease focusing on specific subgroups of patients, including the issue of infertility, a problem which is quite common among females with lupus.

The authors who collaborated in this project have summarized their experience and have presented advances in certain fields related to assessing the severity of these disorders as well as the management of such patients. The book contains six chapters, organized in three sections that cover important research aspects regarding systemic lupus erythematosus.

The first section consists of an introductory chapter prepared by the editor. This chapter presents a brief background about current concepts on the disease and future expectations regarding treatment and long-term outcomes. The next chapter deals with the incidence and prevalence of systemic lupus erythematosus and the findings from epidemiological studies on the risk/preventive factors for this chronic inflammatory disease. It presents factors that have been associated with the etiopathogenesis of lupus or have not yet been elucidated in detail, such as genetic factors and environmental factors, which are thought to play a role in its development. Related to the recent insights of pathogenesis, the next chapter describes a spontaneous mouse model of lupus with review of its histopathologic, serologic, lymphocytic, hormonal, and genetic characteristics as well as its use as a preclinical model for the testing and discovery of new drugs for human use.

The second section discusses the issue of infertility, focusing on reproductive medicine and describing diagnostic and therapeutic strategies used in the last decades that are considered important for lupus patients with infertility since they have improved the related outcomes and consequently the management of pregnancy. However, pregnancies in patients with systemic lupus erythematosus are still considered a high-risk condition due to an increased risk of major obstetrical and neonatal complications. Thus, this section presents the setting of immunologic and hormonal adaptations during pregnancy, including the presence of antiphospholipid antibodies and anti-SSA/Ro, lupus nephritis, and preeclampsia. Finally, the authors provide current knowledge regarding infertility and assisted reproduction technologies, which have emerged as a safe option in patients with systemic lupus erythematosus.

The third section describes neuropsychiatric lupus including the clinical manifestations and its treatment in lupus patients. Based on mouse studies, the authors also discuss the correlation between inflammatory mediators, such as cytokines and autoantibodies, and the development of neurological symptoms with specific emphasis on the evidence for systemic versus local effects, offering a comprehensive review of old and new studies in animal models. This provides insights into how these results align with current treatment strategies offered to patients.

The editor wishes to express his thanks to all the participants in this book for their valuable contributions and to Mrs. Nina Kalinic Babic for her assistance in finalizing the work. Acknowledgment to the IntechOpen staff members responsible for the completion of this book and other publications for free visible knowledge.

#### **Sophia Lionaki, MD, PhD**

Department of Nephrology and Transplantation, Laiko Hospital, National & Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece

### Section 1
