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Background <p>Rapidly progressive interstitial lung disease (RP-ILD) is a severe, often fatal complication in patients with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis (MDA5<sup>+</sup> DM). Early prediction of RP-ILD still remains challenging. We aimed to explore the link between anti-MDA5 IgG subtypes and ILD prognosis in individuals with MDA5<sup>+</sup> DM.</p> Methods <p>In a retrospective study involving 71 MDA5<sup>+</sup> DM-ILD patients, initial serum titers of anti-MDA5 IgG subtypes were measured using indirect immunofluorescence. We then analyzed the associations between these IgG subclasses and the development of RP-ILD.</p> Result <p>Of the 71 patients, 30% developed RP-ILD. RP-ILD patients had a shorter disease course and a higher mortality rate than non-RP-ILD patients (both <i>P</i> &lt; 0.001). A notable link was found between RP-ILD and anti-MDA5 IgG1 (<i>P</i> &lt; 0.05), with 100% of RP-ILD patients showing IgG1 titers ≥ 1:100. Additionally, IgG3 positivity was more prevalent in RP-ILD (<i>P</i> &lt; 0.05). Multivariate logistic regression analysis identified high titers of anti-MDA5 IgG1 and a high neutrophil–lymphocyte ratio (NLR<sup>high≥5.22</sup>) as independent risk factors for RP-ILD (<i>P</i> = 0.020, 0.017, respectively). The combination of anti-MDA5 IgG1 ≥ 1:100 with an NLR ≥ 5.22 improved the predictive accuracy for RP-ILD, yielding an AUC of 0.80.</p> Conclusions <p>Elevated anti-MDA5 IgG1 titers are strongly related to RP-ILD in MDA5<sup>+</sup> DM and function as an important marker for early detection of individuals at high risk. Combining anti-MDA5 IgG1 levels with NLR further enhances predictive accuracy for RP-ILD, offering a practical approach for clinical monitoring and early intervention.</p>

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Anti-MDA5 antibody IgG1 subtype is associated with rapidly progressive interstitial lung disease in anti-MDA5-positive dermatomyositis

  • 期刊论文

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  • 发表日期：

    2025年8月15日

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  • Yun Wu,
  • Yue Wang,
  • Yulu Qiu,
  • Chengying Lv,
  • Yujing Zhu,
  • Lei Wang,
  • Lingxiao Xu,
  • Hanxiao You,
  • Fang Wang,
  • Wenfeng Tan

摘要

Background

Rapidly progressive interstitial lung disease (RP-ILD) is a severe, often fatal complication in patients with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis (MDA5+ DM). Early prediction of RP-ILD still remains challenging. We aimed to explore the link between anti-MDA5 IgG subtypes and ILD prognosis in individuals with MDA5+ DM.

Methods

In a retrospective study involving 71 MDA5+ DM-ILD patients, initial serum titers of anti-MDA5 IgG subtypes were measured using indirect immunofluorescence. We then analyzed the associations between these IgG subclasses and the development of RP-ILD.

Result

Of the 71 patients, 30% developed RP-ILD. RP-ILD patients had a shorter disease course and a higher mortality rate than non-RP-ILD patients (both P < 0.001). A notable link was found between RP-ILD and anti-MDA5 IgG1 (P < 0.05), with 100% of RP-ILD patients showing IgG1 titers ≥ 1:100. Additionally, IgG3 positivity was more prevalent in RP-ILD (P < 0.05). Multivariate logistic regression analysis identified high titers of anti-MDA5 IgG1 and a high neutrophil–lymphocyte ratio (NLRhigh≥5.22) as independent risk factors for RP-ILD (P = 0.020, 0.017, respectively). The combination of anti-MDA5 IgG1 ≥ 1:100 with an NLR ≥ 5.22 improved the predictive accuracy for RP-ILD, yielding an AUC of 0.80.

Conclusions

Elevated anti-MDA5 IgG1 titers are strongly related to RP-ILD in MDA5+ DM and function as an important marker for early detection of individuals at high risk. Combining anti-MDA5 IgG1 levels with NLR further enhances predictive accuracy for RP-ILD, offering a practical approach for clinical monitoring and early intervention.