How would you approach treatment of active inflammatory arthritis in a patient with MCTD (+RNP/+Chromatin) and stable ILD who has failed MMF, azathioprine and methotrexate?

I'd think about Actemra to treat both ILD (with the scleroderma approval) and arthritis.

I second Dr. @Dr. First Last's advice. This is VERY similar to a patient of mine. She (UCTD with inflammatory arthritis and interstitial lung disease after failing numerous agents) went into remission after adding tocilizumab to her hydroxychloroquine.

The other agent I'd consider is abatacept. There...