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Anti-MDA5 RP-ILD Triple Therapy — RACP Adult Medicine MCQ

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HardRheumatologyAnti-MDA5 RP-ILD Triple TherapyRACP Adult Medicine

A 42-year-old with anti-MDA5-positive dermatomyositis develops rapidly progressive hypoxaemic interstitial lung disease over two weeks. Infection has been actively excluded. Which treatment approach is most appropriate?

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Correct answer: E — Use urgent expert combination immunosuppression rather than sequentially waiting for failure of corticosteroid monotherapy

The best answer is “Use urgent expert combination immunosuppression rather than sequentially waiting for failure of corticosteroid monotherapy”. Anti-MDA5-associated rapidly progressive ILD is a high-mortality emergency. Current specialist guidance supports early combination therapy—typically high-dose glucocorticoid with additional agents selected from a calcineurin inhibitor, rituximab, cyclophosphamide, mycophenolate or a JAK inhibitor—rather than slow serial monotherapy. Regimen selection requires rheumatology, respiratory and intensive-care expertise plus infection prophylaxis and monitoring.

Reference: Australian Rheumatology Association: Rheumatoid arthritis: https://rheumatology.org.au/For-Patients/Adult-Medication-Information American College of Rheumatology: Treatment of interstitial lung disease in systemic autoimmune rheumatic diseases: https://rheumatology.org/interstitial-lung-disease-guideline