In systemic lupus erythematosus (SLE), flares can be caused by infections. In particular, Streptococcus pneumoniae infection can be severe or even potentially lethal in absence of previous immunization or in case of 'aggressive' systemic antibiotic therapy. Immunization efficacy, however, can be reduced in such patients with the use of the various immunosuppressive therapeutic regimens. In particular, the use of novel monoclonal antibodies against B lymphocytes raises concerns over the potential interference with antipneumococcal vaccination. Previous studies demonstrated that belimumab therapy did not significantly reduce the efficacy of antipneumococcal vaccination, when received after the initiation of belimumab therapy. The study being evaluated in this article investigated the efficacy of vaccination in relationship to initiation of belimumab therapy in SLE patients.

Systemic lupus erythematosus is an autoimmune disease which afflicts many systems. The precise pathogenesis is still unclear, but strong evidences sustain a multifactorial mechanism, based on the interaction of various genetic, epigenetic, environment, hormonal and immune-regulatory factors. Nowadays, the research interest focuses on cellular and molecular alterations, as results of the complexity of apoptotic process and immune responses acting as initiators and leading to tissue injury. The paper points out on key pathogenic cells, molecules and processes involved in SLE pathogenesis, namely B and T lymphocytes, mast cells, apoptosis, complement system and oxidative stress.