It is well documented in the literature that the onset of clinical symptoms with anti-MDA-5 can be catastrophic, leading to diffuse alveolar damage, respiratory failure, and death.[25,48–50] In an outpatient setting, it is possible to find patients with anti-MDA-5 with a chronic course similar to other myopathies or less severe cases, as shown in the present series.[39]. This evidence concerns the gene IFIH1 and myopathy.