Management of Interstitial Lung Disease in Patients With Myositis Specific Autoantibodies

Inflammatory Muscle Disease (I Lundberg, Section Editor)
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  1. Topical Collection on Inflammatory Muscle Disease

Abstract

Purpose of Review

To review advances in the management of idiopathic inflammatory myopathy-associated interstitial lung disease (IIM-associated ILD) in the past 5 years, with highlights in myositis-specific antibody (MSA) groups.

Recent Findings

With the recent advent of widespread MSA testing, the study of specific homogeneous autoantibody-based subgroups of IIM-associated ILD is now possible. The prevalence, severity, prognosis, and response to treatment are under study for these individual MSAs. Early evidence suggests that PL-7- and PL-12-positive patients are more likely to have ILD and worse severity, compared to Jo-1 patients. Many medications have been efficacious for the treatment of IIM-associated ILD, including calcineurin inhibitors, rituximab, and cyclophosphamide. We suggest vigilant screening and monitoring of ILD in IIM patients with focus on the potential side effects associated with therapy and thus advocate appropriate vaccination, PCP prophylaxis, and bone health protection.

Summary

Many different agents are used to manage patients with ILD with no comparative effectiveness studies to guide the clinician. The possibility of using MSAs to help guide treatment decisions is an appealing, although unproven, focus of research. Unfortunately, the rarity of non-Jo-1 myositis-specific antibodies has precluded robust study of response to treatment and overall management. Ongoing clinical trials and working groups are coordinating efforts to provide evidence-based management.

Keywords

Interstitial lung disease Inflammatory myositis Antisynthetase syndrome Treatment Immunosuppression Autoantibodies 

Notes

Compliance With Ethical Standards

Conflict of Interest

Dr. Christopher-Stine reports personal fees from Mallinckrodt, personal fees from Medimmune, and personal fees from OptionCare, during the conduct of the study. In addition, Dr. Christopher-Stine has a patent to Inova Diagnostics with royalties paid.

Dr. Mecoli has nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Christopher A. Mecoli
    • 1
  • Lisa Christopher-Stine
    • 1
  1. 1.Division of RheumatologyJohns Hopkins University School of MedicineBaltimoreUSA

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