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When Myositis Hits the Lungs: What Every Rheumatologist Should Know About ILD
When idiopathic inflammatory myopathies (IIM) affect the lungs, the consequences can be serious. ILD is not only common in IIM, but also one of the leading causes of death, contributing to up to 80% of mortality in this patient group. For rheumatologists, two subsets stand out: anti-synthetase syndrome (ASyS) and anti-MDA-5 positive dermatomyositis (MDA5-DM). These patients present with distinct clinical clues, very different disease trajectories, and unique treatment challenges. Recognizing ILD early and acting decisively can make the difference between stabilizing a chronic course and facing a rapidly progressive, often fatal decline.
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SLE and Osteoporosis
In one of the SLE sessions at the APLAR 2025 Congress, Prof. Sandra Navarra discussed the assessment and management of osteoporosis in SLE patients, particularly glucocorticoid-induced osteoporosis (GIOP) and this article reviews the highlights and key takeaways from her talk.
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SLE and Osteoporosis
Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease that can present with a variety of signs and symptoms and organ involvement. Comorbidities further complicate the disease course that may lead to poor health-related quality of life and https://t.co/8ZmtLjzbqA
Dr. John Cush RheumNow ( View Tweet)
PAH, when associated with ILD in CTD, worsens prognosis, and poses challenges for treatment
Summary of when PAH should be assessed in patients with ILD and when to perform a right heart catheterization by Prof Kuwana
@RheumNow #APLAR25 https://t.co/g4x4ENzc9k
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Aurelie Najm AurelieRheumo ( View Tweet)
How to treat CTD ILD?
A comparative slide summarizing ACR/BSR and EULAR treatment guidelines
Emphasis on combination of Immunosuppressant and Antifibrotics
@RheumNow #APLAR25 https://t.co/gLSht6QKh5
Aurelie Najm AurelieRheumo ( View Tweet)
A framework for treatment stratified approach in CTD-ILD, by Dr Low Hsiu Ling
Based on
-ILD extent
-Risk of progression
-Biology: fibrosis/inflammation
-Safety
-Other manifestations
@RheumNow #APLAR25 https://t.co/ma5KugzBHy
Aurelie Najm AurelieRheumo ( View Tweet)
Why shall we screen all patients with SSc for ILD?
Focusing screening strategy on patients « at risk » misses 25% of patients with ILD
ILD being the main cause of mortality in SSc
@RheumNow #APLAR25 https://t.co/djzCTdZoVb
Aurelie Najm AurelieRheumo ( View Tweet)
An important message from Prof. @XBaraliakos on D2M-axSpA:
Re-evaluate your diagnosis & check for comorbids before labelling pts as tx-refractory or difficult-to-manage.
consider other causes: FM, other causes of pain
@RheumNow #APLAR25 @rheumarhyme @marklagacmd https://t.co/Lo0yShOK0P
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sheila RHEUMarampa ( View Tweet)
Hyperferritinemia is common in Hyperinflammatory syndromes but is a hallmark of Macrophage activation syndrome and Sepsis; and is a poor prognostic sign too. MAS is excessive activation of T-lymphocytes & macrophages leading to cytokine storm & multi-organ damage. https://t.co/MUKXC0Tw3M
Dr. John Cush RheumNow ( View Tweet)
🆕 Intro to ILD (Part I): the essentials
🫁 Definition & basics
🔬 Key pathology patterns
🧑⚕️ Clinical approach
📋 What rheums need to know
⬇️ Download & learn more: https://t.co/7RzpTDOjwa
Created by @MithuRheum | via @RheumNow for our Rheum to Breathe: ILD Campaign https://t.co/D9d97bqcD5
Dr. John Cush RheumNow ( View Tweet)
PAH diagnosis and management in the context of CTD ILD
Pulmonary arterial hypertension (PAH) is a serious complication of connective tissue disorders (CTD), affecting about 25% of PAH patients. CTD-PAH is the second most common cause after the idiopathic form. PAH involves high https://t.co/UgsdYWv02S
Dr. John Cush RheumNow ( View Tweet)
TNR: Future Treatment of ILD
This Tuesday Night Rheumatology webinar reviewed ACR and EULAR guidelines on interstitial lung disease, with a focus on ‘where are we now and where are we going?’ in regards to treatment strategies and emerging therapies in ILD care. https://t.co/F1fJhWgR5O
Dr. John Cush RheumNow ( View Tweet)
Antifibrotics - A New Class of Therapies in Rheumatology?
Rheumatologists typically manage systemic autoimmune rheumatic diseases (SARD) and associated interstitial lung disease (ILD) with immunosuppressants. However, evidence increasingly supports also the use of antifibrotic https://t.co/IobQagC0ZE
Dr. John Cush RheumNow ( View Tweet)
Cross-sectional study of 320 dermatomyositis (198 classic DM, 122 amyopathic DM/CADM) & compared myositis panels for ANA, MSA, MAA, etc. Comparing CDM vs CADM - ANA pos in 63% vs 49%, p<0.05; MSA+ 47% vs 40% (NS); MAA+ 29% vs 26%(NS); MSA&MAA neg 40% vs 48% (NS)
Dr. John Cush RheumNow ( View Tweet)
Japanese retrospective real world study shows antifibrotic use assoc w/ better survival in Pulm Fibrosis-ILD for 1st 3 yrs & improved survival in progressive pulm. fibrosis (PPF) “despite management” (PPF subset prev Rx non-antifibrotic therapy) https://t.co/caiIuhg7j8 https://t.co/N0ST73TMoR
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Dr. John Cush RheumNow ( View Tweet)
COLCHICORT Trial
The COLCHICORT trial in acute calcium pyrophosphate (CPP) crystal arthritis patients showed that colchicine was inferior to prednisone treatment and that responses were also influenced by other factors.
https://t.co/CC2yVRXbD5 https://t.co/ebLa3FUbGR
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Dr. John Cush RheumNow ( View Tweet)
What to give next?
Bone sequencing therapy provides a novel perspective in #osteoporosis treatment.
Several sequential approaches exist.
Better treatment plan = better patient outcomes
#APLAR25 @RheumNow @rheumarhyme https://t.co/XvwnT9ZCU2
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sheila RHEUMarampa ( View Tweet)
@Lupusreference reviews clinical trials in LES, highlights key limitations of current outcome measures and propose a novel a clinical outcome in SLE based on
« How patients feel function and survive »
Very relevant to the human experience of having a chronic illness
@RheumNow https://t.co/vM58C9KfQ3
Aurelie Najm AurelieRheumo ( View Tweet)
Controversies in ILD
Join leading experts as they tackle complex topics: IPAF, MTX, SARD vs. CTD, and anti-fibrotic therapy.
📅 Sep 16, 2025 | ⏰ 7 PM ET
Jeffrey Sparks, MD | Janet Pope, MD | Elena Joerns, MD
Moderator: Jack Cush, MD
👉 Register: https://t.co/O4FQNyGeTr https://t.co/jIfjuWWNvp
Dr. John Cush RheumNow ( View Tweet)
🆕 Intro to ILD (Part I): the essentials
🫁 Definition & basics
🔬 Key pathology patterns
🧑⚕️ Clinical approach
📋 What rheums need to know
⬇️ Download & learn more: https://t.co/Fn76PiGsPl
Created by @MithuRheum | via @RheumNow for our Rheum to Breathe: ILD Campaign https://t.co/MalDKUjonR
Dr. John Cush RheumNow ( View Tweet)
