Also, patients with anti-MDA5 DM-ILD often have a condition with worse prognosis and were treated with multiple immunosuppressants previously or simultaneously to RTX administration, the risk of infection, especially opportunistic infections, should be considered during the use of RTX, and a low dose of RTX (100 mg every week) may also be applied; In addition, belimumab, a human monoclonal antibody targeting BAFF, may also be considered as a candidate therapy for anti-MDA5 DM-ILD, since some cases in our study showed poor response to RTX treatment. This evidence concerns the gene TNFSF13B and Opportunistic infection.