Pathogenesis and Treatment of Interstitial Lung Disease Accompanied by Anti-melanoma Differentiation-associated Gene 5-positive Idiopathic Inflammatory Myopathies

Intern Med. 2026 Jan 15;65(2):233-244. doi: 10.2169/internalmedicine.6090-25. Epub 2025 Aug 28.

Abstract

Interstitial lung disease (ILD) progresses rapidly and presents with diffuse alveolar damage for patients with anti-melanoma differentiation-associated gene 5 (MDA5)-positive idiopathic inflammatory myopathies. The activation of monocytes/macrophages, B cells, and interferonopathy appears to be involved in the pathogenesis of the disease and can be a therapeutic target. An early diagnosis and intensive immunosuppressive treatment at an early stage are effective for the treatment of ILD. Evidence on treatment, such as the efficacy of Janus kinase inhibitors, rituximab, plasmapheresis, and triple immunosuppressive therapy with glucocorticoids, calcineurin inhibitors, and intravenous cyclophosphamide, has been growing. Careful monitoring of infections and adverse events during intensive immunosuppressive treatment is necessary. It is desirable to elucidate the pathogenesis of the disease, identify indications for intensive treatment, and provide appropriate therapy.

Keywords: Janus kinase inhibitor; autoantibody; dermatomyositis; idiopathic inflammatory myopathy; plasmapheresis; rituximab.

Publication types

  • Review

MeSH terms

  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Interferon-Induced Helicase, IFIH1* / immunology
  • Lung Diseases, Interstitial* / diagnosis
  • Lung Diseases, Interstitial* / etiology
  • Lung Diseases, Interstitial* / immunology
  • Lung Diseases, Interstitial* / therapy
  • Myositis* / complications
  • Myositis* / diagnosis
  • Myositis* / immunology
  • Myositis* / therapy

Substances

  • Interferon-Induced Helicase, IFIH1
  • IFIH1 protein, human
  • Immunosuppressive Agents