Do you recommend maintaining the same monitoring interval of PFTs every 3–6 months with HRCT as indicated for patients with anti-MDA5 dermatomyositis, or do you recommend closer surveillance in this group?

Closer surveillance may be needed at diagnosis of ILD in anti-MDA5 DM at every 3 months for 1st year. But typically, in my experience, patients' symptoms progress faster than every 3 months, so rapidly progressive ILD is diagnosed clinically.

In this group of patients, closer surveillance than what is standard for SARD-ILD in general is warranted. They have a uniquely high risk of rapidly progressive-ILD, and rapid deterioration with high mortality. More so, physiologic decline can lag behind symptoms or radiographic change.

• At baseline...

I think every 3 months in the early course of MDA5, I just get spiro + DLCO to make it easier on the patient. After some degree of stability, I probably would back down to every six months, but would be closely following them early in the course of their illness.