How would you approach management of a patient with seropositive RA and UIP-ILD, with concern for active lung disease?

There is a potential benefit of adding additional immunosuppression for an RA patient with a UIP pattern on HRCT. My go-to-drugs are either abatacept or rituximab. While MMF is a standard first-line medication for many forms of ARD-ILD, it was tried for RA joint disease many years ago and the study was terminated early due to inefficacy. There is reasonable evidence for utility for both rituximab and abatacept in RA-ILD and both are great options for joint disease as well. If ILD continues to progress, then adding nintedanib is also an option. More information on JAKis for RA ILD is appearing in the literature as well.

My argument for abatacept is that there is less impact on response to vaccinations than with rituximab. Currently available ...