Objective:To explore the clinical characteristics and prognostic differences in patients with anti-melanoma differentiation antigen 5(MDA5)positive dermatomyositis(DM)complicated by interstitial lung disease(ILD).Methods:A retrospective analysis was conducted on 272 cases of MDA5-positive DM-ILD patients treated from 2012 to 2021.The patients weredivided into three groups:Group 1(pre-treatment rapidly progres-sive ILD,RPILD),Group 2(post-treatment RPILD),and Group 3(milder ILD).Clinical features,treatment strat-egies,and factors such as corticosteroid dosage were evaluated for prognosis.Results:The study included 219 patients.Group 1 had a shorter disease course,higher rates of fever,anti-nuclear antibodies,and anti-Ro-52 positivity,higher ESR and CRP levels,and lower CD3 and CD4 T-cell counts(P＜0.05).Early mortality rates were higher in Group 1 after 4 and 8 weeks of treatment,while Group 2 showed increased mortality after 12 weeks,and Group 3 had the lowest mortality rate(P＜0.05).Cox analysis revealed that age at onset,lactate de-hydrogenase levels,absence of immunosuppressants usage,and initial corticosteroid dosage were independent risk factors for prognosis in Group 1,while intravenous immunoglobulin was a protective factor for Group 2(P＜0.05).Most Group 2 patients had detectable pathogens during pulmonary exacerbation.Conclusion:MDA5-pos-itive DM-ILD patients exhibit significant clinical heterogeneity and prognosis.RPILD patients do not benefit from high-dose corticosteroid treatment,underscoring a need for new therapeutic strategies.
维普
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