TNF and interstitial lung disease: Given that methotrexate and leflunomide may have lung toxicity and anti-TNF-α could exacerbate existing ILD [80], tofacitinib (5 mg twice daily) was chosen as a disease-modifying anti-rheumatic drug (according to recent observational studies showing that Janus Kinase inhibitors had efficacy on IIM-ILD) [81, 82].